Search results for: N rates

Authors: Chitresh Prasad, Arvind Ramesh, Aditya Virkar, Karan Dholkaria, Vinayak Malhotra

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Solid Propellant Rocket is a rocket that utilises a combination of a solid Oxidizer and a solid Fuel. Success in Solid Rocket Motor design and development depends significantly on knowledge of burning rate behaviour of the selected solid propellant under all motor operating conditions and design limit conditions. Most Solid Motor Rockets consist of the Main Engine, along with multiple Boosters that provide an additional thrust to the space-bound vehicle. Though widely used, they have been eclipsed by Liquid Propellant Rockets, because of their better performance characteristics. The addition of a catalyst such as Iron Oxide, on the other hand, can drastically enhance the performance of a Solid Rocket. This scientific investigation tries to emulate the working of a Solid Rocket using Sparklers and Energized Candles, with a central Energized Candle acting as the Main Engine and surrounding Sparklers acting as the Booster. The Energized Candle is made of Paraffin Wax, with Magnesium filings embedded in it’s wick. The Sparkler is made up of 45% Barium Nitrate, 35% Iron, 9% Aluminium, 10% Dextrin and the remaining composition consists of Boric Acid. The Magnesium in the Energized Candle, and the combination of Iron and Aluminium in the Sparkler, act as catalysts and enhance the burn rates of both materials. This combustion of Metallized Propellants has an influence over the regression rate of the subject candle. The experimental parameters explored here are Separation Distance, Systematically varying Configuration and Layout Symmetry. The major performance parameter under observation is the Regression Rate of the Energized Candle. The rate of regression is significantly affected by the orientation and configuration of the sparklers, which usually act as heat sources for the energized candle. The Overall Efficiency of any engine is factorised by the thermal and propulsive efficiencies. Numerous efforts have been made to improve one or the other. This investigation focuses on the Orientation of Rocket Motor Design to maximize their Overall Efficiency. The primary objective is to analyse the Flame Spread Rate variations of the energized candle, which resembles the solid rocket propellant used in the first stage of rocket operation thereby affecting the Specific Impulse values in a Rocket, which in turn have a deciding impact on their Time of Flight. Another objective of this research venture is to determine the effectiveness of the key controlling parameters explored. This investigation also emulates the exhaust gas interactions of the Solid Rocket through concurrent ignition of the Energized Candle and Sparklers, and their behaviour is analysed. Modern space programmes intend to explore the universe outside our solar system. To accomplish these goals, it is necessary to design a launch vehicle which is capable of providing incessant propulsion along with better efficiency for vast durations. The main motivation of this study is to enhance Rocket performance and their Overall Efficiency through better designing and optimization techniques, which will play a crucial role in this human conquest for knowledge.

Keywords: design modifications, improving overall efficiency, metallized combustion, regression rate variations

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Authors: Magda Milleyde de Sousa Lima, Letícia Lima Aguiar, Marina Guerra Martins, Erika Veríssimo Dias Sousa, Lizandra Sampaio de Oliveira, Lívia Moreira Barros, Joselany Áfio Caetano

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Patients with chronic kidney disease are vulnerable to episodes which make the safety of their health vulnerable, mainly due to the treatment process that exposes them to high rates of interventions during hemodialysis sessions. Some factors associated with health care contribute to the risk of death and complications. However, there are a small number of scientific studies evaluating the level of safety of hemodialysis clinics, and the sociodemographic characteristics of patients and professionals associated with this safety. Therefore, the present study aims to examine the level of patient safety in hemodialysis clinics in the Brazilian capital, to identify the sociodemographic and clinical factors of patients and nursing staff associated with the level of safety. This is an observational, descriptive and quantitative research conducted in three hemodialysis clinics placed in the city of Fortaleza-CE, Brazil, from September to November 2019. The sample was formed after a sample calculation for finite inhabitants of correlation with 200 chronic renal patients, 30 nursing technicians and seven nurses. Conventional sampling was used based on the inclusion criteria: being present at the hemodialysis session on the day the researcher performed the data collection and being 18 years of age or older. Participants who presented communication difficulties to listen to and/or answer the sociodemographic and clinical questionnaire were excluded. Two instruments were applied: sociodemographic and clinical characterization form and Chronic Renal Patient Safety Assessment Scale on Hemodialysis (EASPRCH). The data were analyzed using the Kruskal Walls Test for categorical variables and Spearman correlation coefficient for non-categorical variables, using the Statistical Package SPSS version 20.0. The present study respected the ethical and legal principles determined by resolution 466/2012 of the National Health Council, under the approval of the Ethics and Research Committee with an opinion number: 3,255,635. The results showed that a hemodialysis clinic presented unsafe care practices of 32 points in the EASPRCH (p=0.001). A statistical association was identified between the level of safety and the variables of the patients: level of education (p=0.018), family income (p=0.049), type of employment (p=0.012), venous access site (p=0.009), use of medication during the session (p=0.008) and time of hemodialysis (p=0.002). When evaluating the profile of nurses, a statistical association was evidenced between the level of safety with the variables: marital status (p=0.000), race (p=0.017), schooling (p= 0.000), income (p=0.013), age (p=0.000), clinic workload (p=0.000), time working with hemodialysis (p=0.000), time working in the clinic (p= 0.007) and clinic sizing (p=0.000). In order, the sociodemographic factors of nursing technicians associated with the level of patient safety were: race (p= 0.001) and weekly workload at (p=0.010). Therefore, it is concluded that there is a non-conformity in the level of patient safety in one of the clinics studied and, that sociodemographic and clinical factors of patients and health professionals corroborate the level of safety of the health unit.

Keywords: hemodialysis, nursing, patient safety, quality improvement

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Authors: Elena Samarsky

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According to German national records and willingness to migrate surveys, emigration is much more attractive for better educated citizens employed in white-collar positions, with academics displaying the highest migration rate. The case study of academic migration from Germany is furthermore intriguing due to the country's financial power, competitive labour market and relatively good life-standards, working conditions and high wage rates. Investigation of such mobility challenges traditional economic view on migration, as it raises the question of why people chose to leave their highly-industrialized countries known for their high life-standards, stable political scene and prosperous economy. Within the regional domain, examining mobility of Germans contributes to the ongoing debate over the extent of influence of the EU mobility principle on migration decision. The latter is of particular interest, as it may shed the light on the extent to which it frames individual migration path, defines motivations and colours the experiences of migration action itself. The paper is based on the analysis of the migration decisions obtained through in-depth interviews with German academics employed in the UK. These retrospective interviews were conducted with German academies across selected universities in the UK, employed in a variety of academic fields, and different career stages. Interviews provide a detailed description of what motivated people to search for a post in another country, which attributes of such job are needed to be satisfied in order to facilitate migration, as well as general information on particularities of an academic career and institutions involved. In the course of the project, it became evident that although securing financial stability was non-negotiable factor in migration (e.g., work contract singed before relocation) non-pecuniary motivations played significant role as well. Migration narratives of this group - the highly skilled, whose human capital is transferable, and whose expertise is positively evaluated by countries, is mainly characterised by search for personal development and career advancement, rather than a direct increase in their income. Such records are also consistent in showing that in case of academics, scientific freedom and independence are the main attributes of a perfect job and are a substantial motivator. On the micro level, migration is rather depicted as an opportunistic action addressed in terms of voluntary and rather imposed decision. However, on the macro level, findings allow suggesting that such opportunities are rather an outcome embedded in the peculiarities of academia and its historical and structural developments. This, in turn, contributes significantly to emergence of a scene in which migration action takes place. The paper suggest further comparative research on the intersection of the macro and micro level, and in particular how both national academic institutions and the EU mobility principle shape migration of academics. In light of continuous attempts to make the European labour market more mobile and attractive such findings ought to have direct implications on policy.

Keywords: migration, EU, academics, highly skilled labour

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Authors: Marta Malo, Carlota Soto, Carmen García-Rosales, Teresa Hernández

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SiC based composites are candidates for possible use as structural and functional materials in the future fusion reactors, the main role is intended for the blanket modules. In the blanket, the neutrons produced in the fusion reaction slow down and their energy is transformed into heat in order to finally generate electrical power. In the blanket design named Dual Coolant Lead Lithium (DCLL), a PbLi alloy for power conversion and tritium breeding circulates inside hollow channels called Flow Channel Inserts (FCIs). These FCI must protect the steel structures against the highly corrosive PbLi liquid and the high temperatures, but also provide electrical insulation in order to minimize magnetohydrodynamic interactions of the flowing liquid metal with the high magnetic field present in a magnetically confined fusion environment. Due to their nominally high temperature and radiation stability as well as corrosion resistance, SiC is the main choice for the flow channel inserts. The significantly lower manufacturing cost presents porous SiC (dense coating is required in order to assure protection against corrosion and as a tritium barrier) as a firm alternative to SiC/SiC composites for this purpose. This application requires the materials to be exposed to high radiation levels and extreme temperatures, conditions for which previous studies have shown noticeable changes in both the microstructure and the electrical properties of different types of silicon carbide. Both initial properties and radiation/temperature induced damage strongly depend on the crystal structure, polytype, impurities/additives that are determined by the fabrication process, so the development of a suitable material requires full control of these variables. For this work, several SiC samples with different percentage of porosity and sintering additives have been manufactured by the so-called sacrificial template method at the Ceit-IK4 Technology Center (San Sebastián, Spain), and characterized at Ciemat (Madrid, Spain). Electrical conductivity was measured as a function of temperature before and after irradiation with 1.8 MeV electrons in the Ciemat HVEC Van de Graaff accelerator up to 140 MGy (~ 2·10 -5 dpa). Radiation-induced conductivity (RIC) was also examined during irradiation at 550 ºC for different dose rates (from 0.5 to 5 kGy/s). Although no significant RIC was found in general for any of the samples, electrical conductivity increase with irradiation dose was observed to occur for some compositions with a linear tendency. However, first results indicate enhanced radiation resistance for coated samples. Preliminary thermogravimetric tests of selected samples, together with posterior XRD analysis allowed interpret radiation-induced modification of the electrical conductivity in terms of changes in the SiC crystalline structure. Further analysis is needed in order to confirm this.

Keywords: DCLL blanket, electrical conductivity, flow channel insert, porous SiC, radiation damage, thermal stability

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Authors: Shunhong Qi, Hui Tian

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Triggered off by the forthcoming 2022 Winter Olympics, ski centers are blossoming in China, the number being 742 in 2018. Although the number of skier visits of ski resorts soared to 19.7 million in 2018, one-time skiers account for a considerable portion therein. In light of the extremely low return rates and skiing penetration level (0.5%) of leisure skiing in China, this study proposes and tests a leisure ski service performance framework which assesses the ski resorts’ service quality, skier satisfaction, as well as their impact on skiers’ behavioral intentions, with an aim to assess the success of ski resorts and provide suggestions for improvement. Three self-administered surveys and 16 interviews were conducted upon a convenience sample of leisure skiers in two major ski destinations within two hours’ drive from Beijing – Nanshan and Jundushan ski resorts. Of the 680 questionnaires distributed, 416 usable copies were returned, the response rate being 61.2%. The questionnaire used for the study was developed based on the existing literature of 'push' factors of skiers (intrinsic desire) and 'pull' factors (attractiveness of a destination), as well as leisure sport satisfaction. The scale comprises four parts: skiers’ demographic profiles, their perceived service quality (including ski resorts’ infrastructure, expense, safety and comfort, convenience, daily needs support, skill development support, and accessibility), their overall levels of satisfaction (satisfaction with the service and the experience), and their behavioral intentions (including loyalty, future visitation and greater tolerance of price increases). Skiers’ demographic profiles show that among the 220 males and 196 females in the survey, a vast majority of the skiers are age 17-39 (87.2%). 64.7% are not married, and nearly half (48.3%) of the skiers have a monthly family income exceeding 10,000 yuan (USD 1,424), and 80% are beginners or intermediate skiers. The regression examining the influence of service quality on skier satisfaction reveals that service quality accounts for 44.4% of the variance in skier satisfaction, the variables of safety and comfort, expense, skill development support, and accessibility contributing significantly in descending order. Another regression analyzing the influence of service quality as well as skier satisfaction on their behavioral intentions shows that service quality and skier satisfaction account for 39.1% of the variance in skiers’ behavioral intentions, and the significant predictors are skier satisfaction, safety and comfort, expense, and accessibility, in descending order, though a comparison between groups also indicates that for expert skiers, the significant variables are skier satisfaction, skill development support, safety, and comfort. Suggestions are thus made for ski resorts and other stakeholders to improve skier satisfaction and increase visitation: developing diversified ski courses to meet the demands of skiers of different skiing skills and to reduce crowding, adopting enough chairlifts and magic carpets, reinforcing safety measures and medical force; further exploring their various resources and lower the skiing expense on ski pass, equipment renting, accommodation and dining; adding more bus lines and/or develop platforms for skiers’ car-pooling, and offering diversified skiing activities with local flavors for better entertainment.

Keywords: behavioral intentions, leisure skiing, service quality, skier satisfaction

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Authors: Breanna Wright, Peter Bragge

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Diagnostic error rates in healthcare are approximately 10% of cases. Diagnostic errors can cause patient harm due to inappropriate, inadequate or delayed treatment, and such errors contribute heavily to medical liability claims globally. Therefore, addressing diagnostic error is a high priority. In most cases, diagnostic errors are the result of faulty information synthesis rather than lack of knowledge. Specifically, the majority of diagnostic errors involve cognitive factors, and in particular, cognitive biases. Emergency Departments are an environment with heightened risk of diagnostic error due to time and resource pressures, a frequently chaotic environment, and patients arriving undifferentiated and with minimal context. This project aimed to develop a behavioural, evidence-informed intervention to reduce diagnostic error in Emergency Departments through co-design with emergency physicians, insurers, researchers, hospital managers, citizens and consumer representatives. The Forum Process was utilised to address this aim. This involves convening a small (4 – 6 member) expert panel to guide a focused literature and practice review; convening of a 10 – 12 person citizens panel to gather perspectives of laypeople, including those affected by misdiagnoses; and a 18 – 22 person structured stakeholder dialogue bringing together representatives of the aforementioned stakeholder groups. The process not only provides in-depth analysis of the problem and associated behaviours, but brings together expertise and insight to facilitate identification of a behaviour change intervention. Informed by the literature and practice review, the Citizens Panel focused on eliciting the values and concerns of those affected or potentially affected by diagnostic error. Citizens were comfortable with diagnostic uncertainty if doctors were honest with them. They also emphasised the importance of open communication between doctors and patients and their families. Citizens expect more consistent standards across the state and better access for both patients and their doctors to patient health information to avoid time-consuming re-taking of long patient histories and medication regimes when re-presenting at Emergency Departments and to reduce the risk of unintentional omissions. The structured Stakeholder Dialogue focused on identifying a feasible behavioural intervention to review diagnoses in Emergency Departments. This needed to consider the role of cognitive bias in medical decision-making; contextual factors (in Victoria, there is a legislated 4-hour maximum time between ED triage and discharge / hospital admission); resource availability; and the need to ensure the intervention could work in large metropolitan as well as small rural and regional ED settings across Victoria. The identified behavioural intervention will be piloted in approximately ten hospital EDs across Victoria, Australia. This presentation will detail the findings of all review and consultation activities, describe the behavioural intervention developed and present results of the pilot trial.

Keywords: behavioural intervention, cognitive bias, decision-making, diagnostic error

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Authors: Prescilla Lambert, Christophe Roos, Mounim Lebrini

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For several years, the Caribbean islands and West Africa have had to deal with the massive arrival of the brown seaweed Sargassum. Overall, this macroalgae, which constitutes a habitat for a great diversity of marine organisms, is also an additional stress factor for the marine environment (e.g., coral reefs). In addition, the accumulation followed by the significant decomposition of the Sargassum spp. biomass on the coast leads to the release of toxic gases (H₂S and NH₃), which calls into question the functioning of the economic, health and tourist life of the island and the other interested territories. Originally, these algae are formed by the eutrophication of the oceans accentuated by global warming. Unfortunately, scientists predict a significant recurrence of these Sargassum strandings for years to come. It is therefore more than necessary to find solutions by putting in place a sustainable management plan for this phenomenon. Martinique, a small island in the Caribbean arc, is one of the many areas impacted by Sargassum seaweed strandings. Since 2011, there has been a constant increase in the degradation of the materials present in this region, largely due to toxic/corrosive gases released by the algae decomposition. In order to protect the structures and the vulnerable building materials while limiting the use of synthetic/petroleum based molecules as much as possible, research is being conducted on molecules of natural origin. Thus, thanks to the chemical composition, which comprise molecules with interesting properties, algae such as Sargassum could potentially help to solve many issues. Therefore, this study focuses on the green extraction and characterization of molecules from the species Sargassum fluitans and Sargassum natans present in Martinique. The secondary metabolites found in these extracts showed variability in yield rates due to local climatic conditions. The tests carried out shed light on the anticorrosive and antibacterial potential of the algae. These extracts can thus be described as natural inhibitors. The effect of variation in inhibitor concentrations was tested in electrochemistry using electrochemical impedance spectroscopy and polarization curves. The analysis of electrochemical results obtained by direct immersion in the extracts and self-assembled molecular layers (SAMs) for Sargassum fluitans III, Sargassum natans I and VIII species was conclusive in acid and alkaline environments. The excellent results obtained reveal an inhibitory efficacy of 88% at 50mg/L for the crude extract of Sargassum fluitans III and efficacies greater than 97% for the chemical families of Sargassum fluitans III. Similarly, microbiological tests also suggest a bactericidal character. Results for Sargassum fluitans III crude extract show a minimum inhibitory concentration (MIC) of 0.005 mg/mL on Gram-negative bacteria and a MIC greater than 0.6 mg/mL on Gram-positive bacteria. These results make it possible to consider the management of local and international issues while valuing a biomass rich in biodegradable molecules. The next step in this study will therefore be the evaluation of the toxicity of Sargassum spp..

Keywords: Sargassum, secondary metabolites, anticorrosive, antibacterial, natural inhibitors

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Authors: Blaga Alexandra Cristina, Kloetzer Lenuta, Bompa Amalia Stela, Galaction Anca Irina, Cascaval Dan

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Vitamin B9 is an important member of vitamins B group, being a growth factor, important for making genetic material as DNA and RNA, red blood cells, for building muscle tissues, especially during periods of infancy, adolescence and pregnancy. Its production by biosynthesis is based on the high metabolic potential of mutant Bacillus subtilis, due to a superior biodisponibility compared to that obtained by chemical pathways. Pertraction, defined as the extraction and transport through liquid membranes consists in the transfer of a solute between two aqueous phases of different pH-values, phases that are separated by a solvent layer of various sizes. The pertraction efficiency and selectivity could be significantly enhanced by adding a carrier in the liquid membrane, such as organophosphoric compounds, long chain amines or crown-ethers etc., the separation process being called facilitated pertraction. The aim of the work is to determine the impact of the presence of two extractants/carriers in the bulk liquid membrane, i.e. di(2-ethylhexyl) phosphoric acid (D2EHPA) and lauryltrialkylmetilamine (Amberlite LA2) on the transport kinetics of vitamin B9. The experiments have been carried out using two pertraction equipments for a free liquid membrane or bulk liquid membrane. One pertraction cell consists on a U-shaped glass pipe (used for the dichloromethane membrane) and the second one is an H-shaped glass pipe (used for h-heptane), having 45 mm inner diameter of the total volume of 450 mL, the volume of each compartment being of 150 mL. The aqueous solutions are independently mixed by means of double blade stirrers with 6 mm diameter and 3 mm height, having the rotation speed of 500 rpm. In order to reach high diffusional rates through the solvent layer, the organic phase has been mixed with a similar stirrer, at a similar rotation speed (500 rpm). The area of mass transfer surface, both for extraction and for reextraction, was of 1.59x10-³ m2. The study on facilitated pertraction with the mixture of two carriers, namely D2EHPA and Amberlite LA-2, dissolved in two solvents with different polarities: n-heptane and dichloromethane, indicated the possibility to obtain the synergic effect. The synergism has been analyzed by considering the vitamin initial and final mass flows, as well as the permeability factors through liquid membrane. The synergic effect has been observed at low D2EHPA concentrations and high Amberlite LA-2 concentrations, being more important for the low-polar solvent (n-heptane). The results suggest that the mechanism of synergic pertraction consists on the reaction between the organophosphoric carrier and vitamin B9 at the interface between the feed and membrane phases, while the aminic carrier enhances the hydrophobicity of this compound by solvation. However, the formation of this complex reduced the reextraction rate and, consequently, affects the synergism related to the final mass flows and permeability factor. For describing the influences of carriers concentrations on the synergistic coefficients, some equations have been proposed by taking into account the vitamin mass flows or permeability factors, with an average deviations between 4.85% and 10.73%.

Keywords: pertraction, synergism, vitamin B9, Amberlite LA-2, di(2-ethylhexyl) phosphoric acid

Procedia PDF Downloads 245

Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

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Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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Authors: Alberto Veses, Olga Sanhauja, María Soledad Callén, Tomás García

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The appropriate use of renewable sources emerges as a decisive point to minimize the environmental impact caused by fossil fuels use. Particularly, the use of lignocellulosic biomass becomes one of the best promising alternatives since it is the only carbon-containing renewable source that can produce bioproducts similar to fossil fuels and it does not compete with food market. Among all the processes that can valorize lignocellulosic biomass, pyrolysis is an attractive alternative because it is the only thermochemical process that can produce a liquid biofuel (bio-oil) in a simple way and solid and gas fractions that can be used as energy sources to support the process. However, in order to incorporate bio-oils in current infrastructures and further process in future biorefineries, their quality needs to be improved. Introducing different low-cost catalysts and/or incorporating different polymer residues to the process are some of the new, simple and low-cost strategies that allow the user to directly obtain advanced bio-oils to be used in future biorefineries in an economic way. In this manner, from previous thermogravimetric analyses, local agricultural wastes such as grape seeds (GS) were selected as lignocellulosic biomass while, waste tires (WT) were selected as polymer residue. On the other hand, CaO was selected as low-cost catalyst based on previous experiences by the group. To reach this aim, a specially-designed fixed bed reactor using N₂ as a carrier gas was used. This reactor has the peculiarity to incorporate a vertical mobile liner that allows the user to introduce the feedstock in the oven once the selected temperature (550 ºC) is reached, ensuring higher heating rates needed for the process. Obtaining a well-defined phase distribution in the resulting bio-oil is crucial to ensure the viability to the process. Thus, once experiments were carried out, not only a well-defined two layers was observed introducing several mixtures (reaching values up to 40 wt.% of WT) but also, an upgraded organic phase, which is the one considered to be processed in further biorefineries. Radical interactions between GS and WT released during the pyrolysis process and dehydration reactions enhanced by CaO can promote the formation of better-quality bio-oils. The latter was reflected in a reduction of water and oxygen content of bio-oil and hence, a substantial increase of its heating value and its stability. Moreover, not only sulphur content was reduced from solely WT pyrolysis but also potential and negative issues related to a strong acidic environment of conventional bio-oils were minimized due to its basic pH and lower total acid numbers. Therefore, acidic compounds obtained in the pyrolysis such as CO₂-like substances can react with the CaO and minimize acidic problems related to lignocellulosic bio-oils. Moreover, this CO₂ capture promotes H₂ production from water gas shift reaction favoring hydrogen-transfer reactions, improving the final quality of the bio-oil. These results show the great potential of grapes seeds to carry out the catalytic co-pyrolysis process with different plastic residues in order to produce a liquid bio-oil that can be considered as a high-quality renewable vector.

Keywords: advanced bio-oils, biorefinery, catalytic co-pyrolysis of biomass and waste tires, lignocellulosic biomass

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Authors: Nynne Nørup, Julie Helles Eriksen, Rikke M. Moalem, Else Skjold

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Despite a growing focus on the high environmental impact of textiles, textile waste is only recently considered as part of the waste field. Consequently, there is a general lack of knowledge and data within this field. Particularly the lack of a common perception of textiles generates several problems e.g., to recognize the full material potential the fraction contains, which is cruel if the textile must enter the circular economy. This study aims to qualify a method to make the resources in textile waste visible in a way that makes it possible to move them as high up in the waste hierarchy as possible. Textiles are complex and cover many different types of products, fibers and combinations of fibers and production methods. In garments alone, there is a great variety, even when narrowing it to only undergarments. However, textile waste is often reduced to one fraction, assessed solely by quantity, and compared to quantities of other waste fractions. Disregarding the complexity and reducing textiles to a single fraction that covers everything made of textiles increase the risk of neglecting the value of the materials, both with regards to their properties and economical. Instead of trying to fit textile waste into the current primarily linear waste system where volume is a key part of the business models, this study focused on integrating textile waste as a resource in the design and production phase. The study combined interdisciplinary methods for determining replacement rates used in Life Cycle Assessments and Mass Flow Analysis methods with the designer’s toolbox to hereby activate the properties of textile waste in a way that can unleash its potential optimally. It was hypothesized that by activating Denmark's tradition for design and high level of craftsmanship, it is possible to find solutions that can be used today and create circular resource models that reduce the use of virgin fibers. Through waste samples, case studies, and testing of various design approaches, this study explored how to functionalize the method so that the product after the end-use is kept as a material and only then processed at fiber level to obtain the best environmental utilization. The study showed that the designers' ability to decode the properties of the materials and understanding of craftsmanship were decisive for how well the materials could be utilized today. The later in the life cycle the textiles appeared as waste, the more demanding the description of the materials to be sufficient, especially if to achieve the best possible use of the resources and thus a higher replacement rate. In addition, it also required adaptation in relation to the current production because the materials often varied more. The study found good indications that part of the solution is to use geodata i.e., where in the life cycle the materials were discarded. An important conclusion is that a fully developed method can help support better utilization of textile resources. However, it stills requires a better understanding of materials by the designers, as well as structural changes in business and society.

Keywords: circular economy, development of sustainable processes, environmental impacts, environmental management of textiles, environmental sustainability through textile recycling, interdisciplinary method development, resource optimization, recycled textile materials and the evaluation of recycling, sustainability and recycling opportunities in the textile and apparel sector

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Authors: Mohammad M. Khan, Pankaj Agarwal

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The present investigation deals with the microstructures, mechanical and detailed wear characteristics of in situ TiC particles reinforced zinc aluminum-based metal matrix composites. The composites have been synthesized by liquid metallurgy route using vortex technique. The composite was found to be harder than the matrix alloy due to high hardness of the dispersoid particles therein. The former was also lower in ultimate tensile strength and ductility as compared to the matrix alloy. This could be explained to be due to the use of coarser size dispersoid and larger interparticle spacing. Reasonably uniform distribution of the dispersoid phase in the alloy matrix and good interfacial bonding between the dispersoid and matrix was observed. The composite exhibited predominantly brittle mode of fracture with microcracking in the dispersoid phase indicating effective easy transfer of load from matrix to the dispersoid particles. To study the wear behavior of the samples three different types of tests were performed namely: (i) sliding wear tests using a pin on disc machine under dry condition, (ii) high stress (two-body) abrasive wear tests using different combinations of abrasive media and specimen surfaces under the conditions of varying abrasive size, traversal distance and load, and (iii) low-stress (three-body) abrasion tests using a rubber wheel abrasion tester at various loads and traversal distances using different abrasive media. In sliding wear test, significantly lower wear rates were observed in the case of base alloy over that of the composites. This has been attributed to the poor room temperature strength as a result of increased microcracking tendency of the composite over the matrix alloy. Wear surfaces of the composite revealed the presence of fragmented dispersoid particles and microcracking whereas the wear surface of matrix alloy was observed to be smooth with shallow grooves. During high-stress abrasion, the presence of the reinforcement offered increased resistance to the destructive action of the abrasive particles. Microcracking tendency was also enhanced because of the reinforcement in the matrix. The negative effect of the microcracking tendency was predominant by the abrasion resistance of the dispersoid. As a result, the composite attained improved wear resistance than the matrix alloy. The wear rate increased with load and abrasive size due to a larger depth of cut made by the abrasive medium. The wear surfaces revealed fine grooves, and damaged reinforcement particles while subsurface regions revealed limited plastic deformation and microcracking and fracturing of the dispersoid phase. During low-stress abrasion, the composite experienced significantly less wear rate than the matrix alloy irrespective of the test conditions. This could be explained to be due to wear resistance offered by the hard dispersoid phase thereby protecting the softer matrix against the destructive action of the abrasive medium. Abraded surfaces of the composite showed protrusion of dispersoid phase. The subsurface regions of the composites exhibited decohesion of the dispersoid phase along with its microcracking and limited plastic deformation in the vicinity of the abraded surfaces.

Keywords: abrasive wear, liquid metallurgy, metal martix composite, SEM

Procedia PDF Downloads 123

Authors: Lauren G. Coggins

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Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) are among the most common healthcare-associated infections (HAI), contributing to prolonged lengths of stay, greater costs of patient care, and increased patient mortality. Evidence-based preventative care bundles exist to establish consistent, safe patient-care practices throughout an entire organization, helping to ensure the collective application of care strategies that aim to improve patient outcomes and minimize complications. The cardiac intensive care unit at a nationally ranked teaching and research hospital in the United States exceeded its annual CAUTI and CLABSI targets in the fiscal year 2019, prompting examination into the unit’s infection prevention efforts that included preventative care bundles for both HAIs. Adherence to the CAUTI and CLABSI preventative care bundles was evaluated through frequent audits conducted over three months, using standards and resources from The Joint Commission, a globally recognized leader in quality improvement in healthcare and patient care safety. The bundle elements with the lowest scores were identified as the most commonly missed elements. Three elements from both bundles, six elements in total, served as key content areas for the educational interventions targeted to bedside nurses. The CAUTI elements included appropriate urinary catheter order, appropriate continuation criteria, and urinary catheter care. The CLABSI elements included primary tubing compliance, needleless connector compliance, and dressing change compliance. An integrated, multi-platform education campaign featured content on each CAUTI and CLABSI preventative care bundle in its entirety, with additional reinforcement focused on the lowest scoring elements. One-on-one educational materials included an informational pamphlet, badge buddy, a presentation to reinforce nursing care standards, and real-time application through case studies and electronic health record demonstrations. A digital hub was developed on the hospital’s Intranet for quick access to unit resources, and a bulletin board helped track the number of days since the last CAUTI and CLABSI incident. Audits continued to be conducted throughout the education campaign, and staff were given real-time feedback to address any gaps in adherence. Nearly every nurse in the cardiac intensive care unit received all educational materials, and adherence to all six key bundle elements increased after the implementation of educational interventions. Recommendations from this implementation include providing consistent, comprehensive education across multiple teaching tools and regular audits to track adherence. The multi-platform education campaign brought focus to the evidence-based CAUTI and CLABSI bundles, which in turn will help to reduce CAUTI and CLABSI rates in clinical practice.

Keywords: education, healthcare-associated infections, infection, nursing, prevention

Procedia PDF Downloads 87

Authors: Dimitriu Corneliu-Ioan, Gheorghe FrațIlă

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Romania has one of the highest rates of road deaths among European Union Member States, and there is a concern that the country will not meet its goal of "zero deaths" by 2050. The European Union also aims to halve the number of people seriously injured in road accidents by 2030. Therefore, there is a need to improve road infrastructure safety management in Romania. The aim of this study is to analyze road accident data through statistical methods to assess the current state of road infrastructure safety in Bucharest. The study also aims to identify trends and make forecasts regarding serious road accidents and their consequences. The objective is to provide insights that can help prioritize measures to increase road safety, particularly in urban areas. The research utilizes statistical analysis methods, including exploratory analysis and descriptive statistics. Databases from the Traffic Police and the Romanian Road Authority are analyzed using Excel. Road risks are compared with the main causes of road accidents to identify correlations. The study emphasizes the need for better quality and more diverse collection of road accident data for effective analysis in the field of road infrastructure engineering. The research findings highlight the importance of prioritizing measures to improve road safety in urban areas, where serious accidents and their consequences are more frequent. There is a correlation between the measures ordered by road safety auditors and the main causes of serious accidents in Bucharest. The study also reveals the significant social costs of road accidents, amounting to approximately 3% of GDP, emphasizing the need for collaboration between local and central administrations in allocating resources for road safety. This research contributes to a clearer understanding of the current road infrastructure safety situation in Romania. The findings provide critical insights that can aid decision-makers in allocating resources efficiently and institutionally cooperating to achieve sustainable road safety. The data used for this study are collected from the Traffic Police and the Romanian Road Authority. The data processing involves exploratory analysis and descriptive statistics using the Excel tool. The analysis allows for a better understanding of the factors contributing to the current road safety situation and helps inform managerial decisions to eliminate or reduce road risks. The study addresses the state of road infrastructure safety in Bucharest and analyzes the trends and forecasts regarding serious road accidents and their consequences. It studies the correlation between road safety measures and the main causes of serious accidents. To improve road safety, cooperation between local and central administrations towards joint financial efforts is important. This research highlights the need for statistical data processing methods to substantiate managerial decisions in road infrastructure management. It emphasizes the importance of improving the quality and diversity of road accident data collection. The research findings provide a critical perspective on the current road safety situation in Romania and offer insights to identify appropriate solutions to reduce the number of serious road accidents in the future.

Keywords: road death rate, strategic objective, serious road accidents, road safety, statistical analysis

Procedia PDF Downloads 44

Authors: Anna M. Pretorius

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The emerging markets category for portfolio investment was introduced in 1986 in an attempt to promote capital market development in less developed countries. Investors traditionally diversified their portfolios by investing in different developed markets. However, high growth opportunities forced investors to consider emerging markets as well. Examples include the rapid growth of the “Asian Tigers” during the 1980s, growth in Latin America during the 1990s and the increased interest in emerging markets during the global financial crisis. As such, portfolio flows to emerging markets have increased substantially. In 2002 7% of all equity allocations from advanced economies went to emerging markets; this increased to 20% in 2012. The stronger links between advanced and emerging markets led to increased synchronization of asset price movements. This increased level of stock market integration for emerging markets is confirmed by various empirical studies. Against the background of increased interest in emerging market assets and the increasing level of integration of emerging markets, this paper focuses on the determinants of stock market integration of emerging market countries. Various studies have linked the level of financial market integration with specific economic variables. These variables include: economic growth, local inflation, trade openness, local investment, budget surplus/ deficit, market capitalization, domestic bank credit, domestic institutional and legal environment and world interest rates. The aim of this study is to empirically investigate to what extent trade-related determinants have an impact on stock market integration. The panel data sample include data of 16 emerging market countries: Brazil, Chile, China, Colombia, Czech Republic, Hungary, India, Malaysia, Pakistan, Peru, Philippines, Poland, Russian Federation, South Africa, Thailand and Turkey for the period 1998-2011. The integration variable for each emerging stock market is calculated as the explanatory power of a multi-factor model. These factors are extracted from a large panel of global stock market returns. Trade related explanatory variables include: exports as percentage of GDP, imports as percentage of GDP and total trade as percentage of GDP. Other macroeconomic indicators – such as market capitalisation, the size of the budget deficit and the effectiveness of the regulation of the securities exchange – are included in the regressions as control variables. An initial analysis on a sample of developed stock markets could not identify any significant determinants of stock market integration. Thus the macroeconomic variables identified in the literature are much more significant in explaining stock market integration of emerging markets than stock market integration of developed markets. The three trade variables are all statistically significant at a 5% level. The market capitalisation variable is also significant while the regulation variable is only marginally significant. The global financial crisis has highlighted the urgency to better understand the link between the financial and real sectors of the economy. This paper comes to the important finding that, apart from the level of market capitalisation (as financial indicator), trade (representative of the real economy) is a significant determinant of stock market integration of countries not yet classified as developed economies.

Keywords: emerging markets, financial market integration, panel data, trade

Procedia PDF Downloads 275

Authors: Ana Magana

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Youth are entering the juvenile justice system at alarming rates. For the youth of color entering the system, the outcomes are far worse than for their white counterparts. In fact, the youth of color are more likely to be arrested and sentenced for longer periods of time than white youth. Race disproportionality in the juvenile justice system is evident, but what happens to the youth that exit the juvenile justice system? Who supports them after they are incarcerated and who can prevent them from re-offending? There are several diversion programs that have been implemented in the US to aid the reduction of juvenile incarceration and help reduce recidivism. The program interviewed for this study is a community-based diversion program (CBDP). The CBDP is a pre-filing diversion non-profit organization based in South Seattle. The objective of this exploratory research study is to provide a space and platform for the CBDP team to speak about their background experiences and the influence their background has on their current approach and practice with juveniles. A qualitative, exploratory study was conducted. Interviews were conducted with staff and provided oral consent. The interview included six open-ended, semi-structured questions. Interviews were digitally recoded and transcribed. The aim of this study was to understand how the influence of the participant’s backgrounds and previous experiences impact their current practice approaches with the CBDP youth and young adults. Ecological systems theory was the guiding framework for analysis. After careful analysis, three major themes emerged: 1) strong influence of participant’s background, 2) participants belonging to community and 3) strong self-identity with the CBDP. Within these three themes, subthemes were developed based on participant’s responses. It was concluded that the participant’s approach is influenced by their background experiences. This corresponds to the ecological systems theory and the community-based lens which underscores theoretical analysis. The participant’s approach is grounded in interpersonal relationships within the client’s systems, meaning that the participants understand and view their clients within an ecological systems perspective. When choosing participants that reflect the population being served, the clients receive a balanced, inclusive and caring approach. Youth and young adults are searching for supportive adults to be there for them, it is essential for diversion programs to provide a space for shared background experiences and have people that hold similar identities. Grassroots organizations such as CBDP have the tools and experience to work with marginalized populations that are constantly being passed on. While articles and studies focus on the reduction of recidivism and re-offending it is important to question the reasons behind this data. For instance, there can be a reduction in statistics, but at whose expense. Are the youth and young adults truly being supported? Or is it just a requirement that they are completing in order to remove their charge? This research study can serve as the beginning of a series of studies conducted at CBDP to further understand and validate the need to employ individuals with similar backgrounds as the participants CBDP serves.

Keywords: background experience, diversion, ecological systems theory, relationships

Procedia PDF Downloads 127

Authors: Mariia Karizhenskaia, Tanvi Nandani, Ali Tafazoli Moghadam

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Hospice palliative care (HPC) is one of the most complicated philosophies of care in which physical, social/cultural, and spiritual aspects of human life are intermingled with an undeniably significant role in every aspect. Among these dimensions of care, culture possesses an outstanding position in the process and goal determination of HPC. This study shows the importance of cultural elements in the establishment of effective and optimized structures of HPC in the Canadian healthcare environment. Our systematic search included Medline, Google Scholar, and St. Lawrence College Library, considering original, peer-reviewed research papers published from 1998 to 2023 to identify recent national literature connecting culture and palliative care delivery. The most frequently presented feature among the articles is the role of culture in the efficiency of the HPC. It has been shown frequently that including the culturespecific parameters of each nation in this system of care is vital for its success. On the other hand, ignorance about the exclusive cultural trends in a specific location has been accompanied by significant failure rates. Accordingly, implementing a culture-wise adaptable approach is mandatory for multicultural societies. The following outcome of research studies in this field underscores the importance of culture-oriented education for healthcare staff. Thus, all the practitioners involved in HPC will recognize the importance of traditions, religions, and social habits for processing the care requirements. Cultural competency training is a telling sample of the establishment of this strategy in health care that has come to the aid of HPC in recent years. Another complexity of the culturized HPC nowadays is the long-standing issue of racialization. Systematic and subconscious deprivation of minorities has always been an adversity of advanced levels of care. The last part of the constellation of our research outcomes is comprised of the ethical considerations of culturally driven HPC. This part is the most sophisticated aspect of our topic because almost all the analyses, arguments, and justifications are subjective. While there was no standard measure for ethical elements in clinical studies with palliative interventions, many research teams endorsed applying ethical principles for all the involved patients. Notably, interpretations and projections of ethics differ in varying cultural backgrounds. Therefore, healthcare providers should always be aware of the most respectable methodologies of HPC on a case-by-case basis. Cultural training programs have been utilized as one of the main tactics to improve the ability of healthcare providers to address the cultural needs and preferences of diverse patients and families. In this way, most of the involved health care practitioners will be equipped with cultural competence. Considerations for ethical and racial specifications of the clients of this service will boost the effectiveness and fruitfulness of the HPC. Canadian society is a colorful compilation of multiple nationalities; accordingly, healthcare clients are diverse, and this divergence is also translated into HPC patients. This fact justifies the importance of studying all the cultural aspects of HPC to provide optimal care on this enormous land.

Keywords: cultural competence, end-of-life care, hospice, palliative care

Procedia PDF Downloads 45

Authors: Sıdıka Kaya, Gülay Sain Güven, Seda Karsavuran, Onur Toka

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This study is part of an ongoing research project supported by the Scientific and Technological Research Council of Turkey (TUBITAK) under Project Number 114K404, and participation to this conference was supported by Hacettepe University Scientific Research Coordination Unit under Project Number 10243. Evaluation of hospital readmissions is gaining importance in terms of quality and cost, and is becoming the target of national policies. In Turkey, the topic of hospital readmission is relatively new on agenda and very few studies have been conducted on this topic. The aim of this study was to determine 30-day readmission rates and risk factors for readmission. Whether readmission was planned, related to the prior admission and avoidable or not was also assessed. The study was designed as a ‘prospective cohort study.’ 472 patients hospitalized in internal medicine departments of a university hospital in Turkey between February 1, 2015 and April 30, 2015 were followed up. Analyses were conducted using IBM SPSS Statistics version 22.0 and SPSS Modeler 16.0. Average age of the patients was 56 and 56% of the patients were female. Among these patients 95 were readmitted. Overall readmission rate was calculated as 20% (95/472). However, only 31 readmissions were unplanned. Unplanned readmission rate was 6.5% (31/472). Out of 31 unplanned readmission, 24 was related to the prior admission. Only 6 related readmission was avoidable. To determine risk factors for readmission we constructed Chi-square automatic interaction detector (CHAID) decision tree algorithm. CHAID decision trees are nonparametric procedures that make no assumptions of the underlying data. This algorithm determines how independent variables best combine to predict a binary outcome based on ‘if-then’ logic by portioning each independent variable into mutually exclusive subsets based on homogeneity of the data. Independent variables we included in the analysis were: clinic of the department, occupied beds/total number of beds in the clinic at the time of discharge, age, gender, marital status, educational level, distance to residence (km), number of people living with the patient, any person to help his/her care at home after discharge (yes/no), regular source (physician) of care (yes/no), day of discharge, length of stay, ICU utilization (yes/no), total comorbidity score, means for each 3 dimensions of Readiness for Hospital Discharge Scale (patient’s personal status, patient’s knowledge, and patient’s coping ability) and number of daycare admissions within 30 days of discharge. In the analysis, we included all 95 readmitted patients (46.12%), but only 111 (53.88%) non-readmitted patients, although we had 377 non-readmitted patients, to balance data. The risk factors for readmission were found as total comorbidity score, gender, patient’s coping ability, and patient’s knowledge. The strongest identifying factor for readmission was comorbidity score. If patients’ comorbidity score was higher than 1, the risk for readmission increased. The results of this study needs to be validated by other data–sets with more patients. However, we believe that this study will guide further studies of readmission and CHAID is a useful tool for identifying risk factors for readmission.

Keywords: decision tree, hospital, internal medicine, readmission

Procedia PDF Downloads 218

Authors: J. Yang, M. Monnot, T. Eljaddi, L. Simonian, L. Ercolei, P. Moulin

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The application of membrane technology to wastewater treatment has expanded rapidly under increasing stringent legislation and environmental protection requirements. At the same time, the water resource is becoming precious, and water reuse has gained popularity. Particularly, ultrafiltration (UF) is a very promising technology for water reuse as it can retain organic matters, suspended solids, colloids, and microorganisms. Nevertheless, few studies dealing with operating optimization of UF as a tertiary treatment for water reuse on a semi-industrial scale appear in the literature. Therefore, this study aims to explore the permeate water quality and to optimize operating parameters (maximizing productivity and minimizing irreversible fouling) through the operation of a UF pilot plant under real conditions. The fully automatic semi-industrial UF pilot plant with periodic classic backwashes (CB) and air backwashes (AB) was set up to filtrate the secondary effluent of an urban wastewater treatment plant (WWTP) in France. In this plant, the secondary treatment consists of a conventional activated sludge process followed by a sedimentation tank. The UF process was thus defined as a tertiary treatment and was operated under constant flux. It is important to note that a combination of CB and chlorinated AB was used for better fouling management. The 200 kDa hollow fiber membrane was used in the UF module, with an initial permeability (for WWTP outlet water) of 600 L·m-2·h⁻¹·bar⁻¹ and a total filtration surface of 9 m². Fifteen filtration conditions with different fluxes, filtration times, and air backwash frequencies were operated for more than 40 hours of each to observe their hydraulic filtration performances. Through comparison, the best sustainable condition was flux at 60 L·h⁻¹·m⁻², filtration time at 60 min, and backwash frequency of 1 AB every 3 CBs. The optimized condition stands out from the others with > 92% water recovery rates, better irreversible fouling control, stable permeability variation, efficient backwash reversibility (80% for CB and 150% for AB), and no chemical washing occurrence in 40h’s filtration. For all tested conditions, the permeate water quality met the water reuse guidelines of the World Health Organization (WHO), French standards, and the regulation of the European Parliament adopted in May 2020, setting minimum requirements for water reuse in agriculture. In permeate: the total suspended solids, biochemical oxygen demand, and turbidity were decreased to < 2 mg·L-1, ≤ 10 mg·L⁻¹, < 0.5 NTU respectively; the Escherichia coli and Enterococci were > 5 log removal reduction, the other required microorganisms’ analysis were below the detection limits. Additionally, because of the COVID-19 pandemic, coronavirus SARS-CoV-2 was measured in raw wastewater of WWTP, UF feed, and UF permeate in November 2020. As a result, the raw wastewater was tested positive above the detection limit but below the quantification limit. Interestingly, the UF feed and UF permeate were tested negative to SARS-CoV-2 by these PCR assays. In summary, this work confirms the great interest in UF as intensified tertiary treatment for water reuse and gives operational indications for future industrial-scale production of reclaimed water.

Keywords: semi-industrial UF pilot plant, water reuse, fouling management, coronavirus

Procedia PDF Downloads 88

Authors: Scott M. Black, Craig Maclean, Pauline Hall Barrientos, Konstantinos Ritos, Asimina Kazakidi

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Aortic aneurysms and dissections are leading causes of death in cardiovascular disease. Both inevitably lead to hemodynamic instability without surgical intervention in the form of vascular stent-graft deployment. An accurate description of the aortic geometry and blood flow in patient-specific cases is vital for treatment planning and long-term success of such grafts, as they must generate physiological branch perfusion and in-stent hemodynamics. The aim of this study was to create patient-specific computational fluid dynamics (CFD) models through a multi-modality, multi-dimensional approach with boundary condition optimization to predict branch flow rates and in-stent hemodynamics in custom stent-graft configurations. Three-dimensional (3D) thoracoabdominal aortae were reconstructed from four-dimensional flow-magnetic resonance imaging (4D Flow-MRI) and computed tomography (CT) medical images. The former employed a novel approach to generate and enhance vessel lumen contrast via through-plane velocity at discrete, user defined cardiac time steps post-hoc. To produce patient-specific boundary conditions (BCs), the aortic geometry was reduced to a one-dimensional (1D) model. Thereafter, a zero-dimensional (0D) 3-Element Windkessel model (3EWM) was coupled to each terminal branch to represent the distal vasculature. In this coupled 0D-1D model, the 3EWM parameters were optimized to yield branch flow waveforms which are representative of the 4D Flow-MRI-derived in-vivo data. Thereafter, a 0D-3D CFD model was created, utilizing the optimized 3EWM BCs and a 4D Flow-MRI-obtained inlet velocity profile. A sensitivity analysis on the effects of stent-graft configuration and BC parameters was then undertaken using multiple stent-graft configurations and a range of distal vasculature conditions. 4D Flow-MRI granted unparalleled visualization of blood flow throughout the cardiac cycle in both the pre- and postsurgical states. Segmentation and reconstruction of healthy and stented regions from retrospective 4D Flow-MRI images also generated 3D models with geometries which were successfully validated against their CT-derived counterparts. 0D-1D coupling efficiently captured branch flow and pressure waveforms, while 0D-3D models also enabled 3D flow visualization and quantification of clinically relevant hemodynamic parameters for in-stent thrombosis and graft limb occlusion. It was apparent that changes in 3EWM BC parameters had a pronounced effect on perfusion distribution and near-wall hemodynamics. Results show that the 3EWM parameters could be iteratively changed to simulate a range of graft limb diameters and distal vasculature conditions for a given stent-graft to determine the optimal configuration prior to surgery. To conclude, this study outlined a methodology to aid in the prediction post-surgical branch perfusion and in-stent hemodynamics in patient specific cases for the implementation of custom stent-grafts.

Keywords: 4D flow-MRI, computational fluid dynamics, vascular stent-grafts, windkessel

Procedia PDF Downloads 148

Authors: Jennifer Kehinde, Claire O’Donnell, Annmarie Grealish

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Introduction: Breastfeeding has been shown to provide numerous health benefits for both infants and mothers. The decision to breastfeed is influenced by physiological, psychological, and emotional factors. However, the importance of equipping mothers with the necessary knowledge for successful breastfeeding practice cannot be ruled out. The decline in global breastfeeding rate can be linked to a lack of adequate breastfeeding education during the prenatal stage. This systematic review examined the effectiveness of prenatal breastfeeding education on breastfeeding uptake postpartum. Method: This review was undertaken and reported in conformity with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement (PRISMA) and was registered on the international prospective register for systematic reviews (PROSPERO: CRD42020213853). A PICO analysis (population, intervention, comparison, outcome) was undertaken to inform the choice of keywords in the search strategy to formulate the review question, which was aimed at determining the effectiveness of prenatal breastfeeding educational programs in improving breastfeeding uptake following birth. A systematic search of five databases (Cumulative Index to Nursing and Allied Health Literature, Medline, Psych INFO, and Applied Social Sciences Index and Abstracts) was searched between January 2014 until July 2021 to identify eligible studies. Quality assessment and narrative synthesis were subsequently undertaken. Results: Fourteen studies were included. All 14 studies used different types of breastfeeding programs; eight used a combination of curriculum-based breastfeeding education programs, group prenatal breastfeeding counselling, and one-to-one breastfeeding educational programs, which were all delivered in person; four studies used web-based learning platforms to deliver breastfeeding education prenatally which were both delivered online and face to face over a period of 3 weeks to 2 months with follow-up periods ranging from 3 weeks to 6 months; one study delivered breastfeeding educational intervention using mother-to-mother breastfeeding support groups in promoting exclusive breastfeeding, and one study disseminated breastfeeding education to participants based on the theory of planned behaviour. The most effective interventions were those that included both theory and hands-on demonstrations. Results showed an increase in breastfeeding uptake, breastfeeding knowledge, an increase in a positive attitude to breastfeeding, and an increase in maternal breastfeeding self-efficacy among mothers who participated in breastfeeding educational programs during prenatal care. Conclusion: Prenatal breastfeeding education increases women’s knowledge of breastfeeding. Mothers who are knowledgeable about breastfeeding and hold a positive approach towards breastfeeding have the tendency to initiate breastfeeding and continue for a lengthened period. Findings demonstrate a general correlation between prenatal breastfeeding education and increased breastfeeding uptake postpartum. The high level of positive breastfeeding outcomes inherent in all the studies can be attributed to prenatal breastfeeding education. This review provides rigorous contemporary evidence that healthcare professionals and policymakers can apply when developing effective strategies to improve breastfeeding rates and ultimately improve the health outcomes of mothers and infants.

Keywords: breastfeeding, breastfeeding programs, breastfeeding self-efficacy, prenatal breastfeeding education

Procedia PDF Downloads 53

Authors: Kunal Garg, Louise Theusen Hermansan, Kanoktip Puttaraska, Oliver Hendricks, Heidi Pirttinen, Leona Gilbert

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The Germ Theory (one infectious determinant is equal to one disease) has unarguably evolved our capability to diagnose and treat infectious diseases over the years. Nevertheless, the advent of technology, climate change, and volatile human behavior has brought about drastic changes in our environment, leading us to question the relevance of the Germ Theory in our day, i.e. will vector-borne disease (VBD) sufferers produce multiple immune responses when tested for multiple microbes? Vector diseased patients producing multiple immune responses to different microbes would evidently suggest human polymicrobial infections (HPI). Ongoing diagnostic tools are exceedingly unequipped with the current research findings that would aid in diagnosing patients for polymicrobial infections. This shortcoming has caused misdiagnosis at very high rates, consequently diminishing the patient’s quality of life due to inadequate treatment. Equipped with the state-of-art scientific knowledge, PolyScan intends to address the pitfalls in current VBD diagnostics. PolyScan is a multiplex and multifunctional enzyme linked Immunosorbent assay (ELISA) platform that can test for numerous VBD microbes and allow simultaneous screening for multiple types of antibodies. To validate PolyScan, Lyme Borreliosis (LB) and spondyloarthritis (SpA) patient groups (n = 54 each) were tested for Borrelia burgdorferi, Borrelia burgdorferi Round Body (RB), Borrelia afzelii, Borrelia garinii, and Ehrlichia chaffeensis against IgM and IgG antibodies. LB serum samples were obtained from Germany and SpA serum samples were obtained from Denmark under relevant ethical approvals. The SpA group represented chronic LB stage because reactive arthritis (SpA subtype) in the form of Lyme arthritis links to LB. It was hypothesized that patients from both the groups will produce multiple immune responses that as a consequence would evidently suggest HPI. It was also hypothesized that the multiple immune response proportion in SpA patient group would be significantly larger when compared to the LB patient group across both antibodies. It was observed that 26% LB patients and 57% SpA patients produced multiple immune responses in contrast to 33% LB patients and 30% SpA patients that produced solitary immune responses when tested against IgM. Similarly, 52% LB patients and an astounding 73% SpA patients produced multiple immune responses in contrast to 30% LB patients and 8% SpA patients that produced solitary immune responses when tested against IgG. Interestingly, IgM immune dysfunction in both the patient groups was also recorded. Atypically, 6% of the unresponsive 18% LB with IgG antibody was recorded producing multiple immune responses with the IgM antibody. Similarly, 12% of the unresponsive 19% SpA with IgG antibody was recorded producing multiple immune responses with the IgM antibody. Thus, results not only supported hypothesis but also suggested that IgM may atypically prevail longer than IgG. The PolyScan concept will aid clinicians to detect patients for early, persistent, late, polymicrobial, & immune dysfunction conditions linked to different VBD. PolyScan provides a paradigm shift for the VBD diagnostic industry to follow that will drastically shorten patient’s time to receive adequate treatment.

Keywords: diagnostics, immune dysfunction, polymicrobial, TICK-TAG

Procedia PDF Downloads 301

Authors: Deepak Loura

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Climate change is considered one of the major environmental problems of the 21st century and a lasting change in the statistical distribution of weather patterns over periods ranging from decades to millions of years. Agriculture and climate change are internally correlated with each other in various aspects, as the threat of varying global climate has greatly driven the attention of scientists, as these variations are imparting a negative impact on global crop production and compromising food security worldwide. The fast pace of development and industrialization and indiscriminate destruction of the natural environment, more so in the last century, have altered the concentration of atmospheric gases that lead to global warming. Carbon dioxide (CO₂), methane (CH₄), and nitrous oxide (NO) are important biogenic greenhouse gases (GHGs) from the agricultural sector contributing to global warming and their concentration is increasing alarmingly. Agricultural productivity can be affected by climate change in 2 ways: first, directly, by affecting plant growth development and yield due to changes in rainfall/precipitation and temperature and/or CO₂ levels, and second, indirectly, there may be considerable impact on agricultural land use due to snow melt, availability of irrigation, frequency and intensity of inter- and intra-seasonal droughts and floods, soil organic matter transformations, soil erosion, distribution and frequency of infestation by insect pests, diseases or weeds, the decline in arable areas (due to submergence of coastal lands), and availability of energy. An increase in atmospheric CO₂ promotes the growth and productivity of C3 plants. On the other hand, an increase in temperature, can reduce crop duration, increase crop respiration rates, affect the equilibrium between crops and pests, hasten nutrient mineralization in soils, decrease fertilizer- use efficiencies, and increase evapotranspiration among others. All these could considerably affect crop yield in long run. Climate resilient agriculture consisting of adaptation, mitigation, and other agriculture practices can potentially enhance the capacity of the system to withstand climate-related disturbances by resisting damage and recovering quickly. Climate resilient agriculture turns the climate change threats that have to be tackled into new business opportunities for the sector in different regions and therefore provides a triple win: mitigation, adaptation, and economic growth. Improving the soil organic carbon stock of soil is integral to any strategy towards adapting to and mitigating the abrupt climate change, advancing food security, and improving the environment. Soil carbon sequestration is one of the major mitigation strategies to achieve climate-resilient agriculture. Climate-smart agriculture is the only way to lower the negative impact of climate variations on crop adaptation before it might affect global crop production drastically. To cope with these extreme changes, future development needs to make adjustments in technology, management practices, and legislation. Adaptation and mitigation are twin approaches to bringing resilience to climate change in agriculture.

Keywords: climate change, global warming, crop production, climate resilient agriculture

Procedia PDF Downloads 46

Authors: Jacques M. Berner, Lehlogonolo Maloma

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Context: Glyphosate, a widely used herbicide, has raised concerns about its impact on various crops. Amaranthus cruentus, an important grain crop species, is particularly susceptible to glyphosate. Understanding the specific disruptions caused by glyphosate on the photosynthetic process in Amaranthus cruentus is crucial for assessing its effects on crop productivity and ecological sustainability. Research Aim: This study aimed to investigate the dose-dependent impact of glyphosate on the photochemical efficiency of Amaranthus cruentus using the OJIP transient analysis. The goal was to assess the specific disruptions caused by glyphosate on key parameters of photosystem II. Methodology: The experiment was conducted in a controlled greenhouse environment. Amaranthus cruentus plants were exposed to different concentrations of glyphosate, including half, recommended, and double the recommended application rates. The photochemical efficiency of the plants was evaluated using non-invasive chlorophyll a fluorescence measurements and subsequent analysis of OJIP transients. Measurements were taken on 1-hour dark-adapted leaves using a Hansatech Handy PEA+ chlorophyll fluorimeter. Findings: The study's results demonstrated a significant reduction in the photochemical efficiency of Amaranthus cruentus following glyphosate treatment. The OJIP transients showed distinct alterations in the glyphosate-treated plants compared to the control group. These changes included a decrease in maximal fluorescence (FP) and a delay in the rise of the fluorescence signal, indicating impairment in the energy conversion process within the photosystem II. Glyphosate exposure also led to a substantial decrease in the maximum quantum yield efficiency of photosystem II (FV/FM) and the total performance index (PItotal), which reflects the overall photochemical efficiency of photosystem II. These reductions in photochemical efficiency were observed even at half the recommended dose of glyphosate. Theoretical Importance: The study provides valuable insights into the specific disruptions caused by glyphosate on the photochemical efficiency of Amaranthus cruentus. Data Collection and Analysis Procedures: Data collection involved non-invasive chlorophyll a fluorescence measurements using a chlorophyll fluorimeter on dark-adapted leaves. The OJIP transients were then analyzed to assess specific disruptions in key parameters of photosystem II. Statistical analysis was conducted to determine the significance of the differences observed between glyphosate-treated plants and the control group. Question Addressed: The study aimed to address the question of how glyphosate exposure affects the photochemical efficiency of Amaranthus cruentus, specifically examining disruptions in the photosynthetic electron transport chain and overall photochemical efficiency. Conclusion: The study demonstrates that glyphosate severely impairs the photochemical efficiency of Amaranthus cruentus, as indicated by the alterations in OJIP transients. Even at half the recommended dose, glyphosate caused significant reductions in photochemical efficiency. These findings highlight the detrimental effects of glyphosate on crop productivity and emphasize the need for further research to evaluate its long-term consequences and ecological implications in agriculture. The authors gratefully acknowledge the support from North-West University for making this research possible.

Keywords: glyphosate, amaranthus cruentus, ojip transient analysis, pitotal, photochemical efficiency, chlorophyll fluorescence, weeds

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Authors: Tolga Levent

Abstract:

Throughout the past few decades, forced immigration has been a significant problem for many developing countries. Turkey is one of those countries, which has experienced lots of forced immigration waves in the Republican era. However, the ongoing forced immigration wave of Syrians started with Syrian Civil War in 2011, is strikingly influential due to its intensity. In six years, approximately 3,4 million Syrians have entered to Turkey and presented high-level spatial concentrations in certain cities proximate to the Syrian border. These concentrations make Syrians and their problems relatively visible, especially in those cities. The problems of Syrians in Turkish cities could be associated with all dimensions of daily lives. Within economical dimension, high rates of Syrian unemployment push them to informal jobs offering very low wages. The financial aids they continuously demand from public authorities trigger anti-Syrian behaviors of local communities. Moreover, their relatively limited social adaptation capacities increase integration problems within social dimension day by day. Even, there are problems related to public health dimension such as the reappearance of certain child's illnesses due to the insufficiency of vaccination of Syrian children. These problems are significant but relatively easy to be prevented by using different types of management strategies and structural policies. However, there are other types of problems -urban problems- emerging with socio-spatial impacts of Syrians on Turkish cities in a very short period of time. There are relatively limited amount of studies about these impacts since they are difficult to be comprehended. The aim of the study, in this respect, is to understand these rapidly-emerging impacts and urban problems resulted from this massive immigration influx and to discuss new qualities of urban planning facing them. In the first part, there is a brief historical consideration of forced immigration waves in Turkey. These waves are important to make comparison with the ongoing immigration wave and to understand its significance. The second part is about quantitative and qualitative analyses of the spatial existence of Syrian immigrants in the city of Mersin, as an example of cities where Syrians are highly concentrated. By using official data from public authorities, quantitative statistical analyses are made to detect spatial concentrations of Syrians at neighborhood level. As methods of qualitative research, observations and in-depth interviews are used to define socio-spatial impacts of Syrians. The main results show that there emerges 'cities in cities' though sharp socio-spatial segregations which change density surfaces; produce unforeseen land-use patterns; result in inadequacies of public services and create degradations/deteriorations of urban environments occupied by Syrians. All these problems are significant; however, Turkish planning system does not have a capacity to cope with them. In the final part, there is a discussion about new qualities of urban planning facing these impacts and urban problems. The main point of discussion is the possibility of resilient urban planning under the conditions of uncertainty and unpredictability fostered by immigration crisis. Such a resilient planning approach might provide an option for countries aiming to cope with negative socio-spatial impacts of massive immigration influxes.

Keywords: cities, forced immigration, Syrians, urban planning

Procedia PDF Downloads 228

Authors: Mark Hocking

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There is concern about the potential impact environmental flooding may have on groundwater levels and salinity processes in the Murray-Darling Basin. A study was undertaken to determine if environmental flooding of the Gunbower Forest has an impact on groundwater level and salinity which is in Victoria, Australia. To assess the impact, Impulse Response Functions (IRFs) are applied to time series groundwater monitoring well data in the area surrounding Gunbower Forest. It is found that rainfall is the primary driver of seasonal water table fluctuation, and the Murray River water level is a secondary contributor to the water table fluctuations. The dominant process that influenced the long-term water table level and salinity conditions is associated with pressure changes in the deep regional aquifer. The study demonstrates that groundwater level fluctuations in the vicinity of Gunbower Forest do not correlate with flooding (natural or managed). Groundwater recharge is calculated by applying the bore hydrograph method to the rainfall-attributed forcing function fluctuations. Data collected from thirty-three bores between 1990 to 2020 is processed to determine a 30-year average groundwater recharge rate. A 5% specific yield of the unconfined aquifer is assumed based on previously published data. It is found that the rainfall-attributed mean annual groundwater recharge varied between 2 mm/year and 189 mm/year with a median of 33.6 mm/year. Surface water recharge is also calculated by analysing the surface water attributed forcing function fluctuations and found to be as high as 37 mm/year, with most of the high values in the vicinity of rivers or agricultural land. There is a long-term regional aquifer declining trend where most water table bores have an average falling trend of 20 cm/year independent of rainfall over the past 30 years. It is found that the groundwater level beneath the Gunbower Forest is dominated by groundwater evapotranspiration. Evapotranspiration lowers the water table by as much as 0.5 m within the forest, thereby causing a relative groundwater level depression under the Gunbower Forest. Historical data shows that groundwater salinity in the area varies and has an electrical conductivity of up to 45 000 µS/cm (comparable to seawater). High groundwater salinity occurs both within and outside the Gunbower Forest as well as adjacent to the Murray River. Available groundwater salinity data suggests trends are generally stable; however, data quality and collection frequency could be improved. This study shows that at the majority of locations analyzed, the groundwater recharge occurred due to both rainfall and water loss from the Murray River. It is found that Deep groundwater pressures determined the base groundwater level, and the fluctuation of the deeper aquifer pressures determined the environmental interaction at the water surface. Local groundwater processes, such as high evapotranspiration rates in Gunbower Forest, have the capacity to lower the water table locally. The rise or fall of the regional aquifer water level has the greatest influence on the groundwater salinity in and around Gunbower Forest.

Keywords: groundwater data interpretation, groundwater monitoring, hydrogeology, impulse response function

Procedia PDF Downloads 29

Authors: Sabrina Neururer, Marco Schweitzer, Werner Hackl, Bernhard Tilg, Patrick Raudaschl, Andreas Huber, Bernhard Pfeifer

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History and the current outbreak of Covid-19 have shown the deadly potential of infectious diseases. However, infectious diseases also have a serious impact on areas other than health and healthcare, such as the economy or social life. These areas are strongly codependent. Therefore, disease control measures, such as social distancing, quarantines, curfews, or lockdowns, have to be adopted in a very considerate manner. Infectious disease modeling can support policy and decision-makers with adequate information regarding the dynamics of the pandemic and therefore assist in planning and enforcing appropriate measures that will prevent the healthcare system from collapsing. In this work, an agent-based simulation package named “survival” for simulating infectious diseases is presented. A special focus is put on SARS-Cov-2. The presented simulation package was used in Austria to model the SARS-Cov-2 outbreak from the beginning of 2020. Agent-based modeling is a relatively recent modeling approach. Since our world is getting more and more complex, the complexity of the underlying systems is also increasing. The development of tools and frameworks and increasing computational power advance the application of agent-based models. For parametrizing the presented model, different data sources, such as known infections, wastewater virus load, blood donor antibodies, circulating virus variants and the used capacity for hospitalization, as well as the availability of medical materials like ventilators, were integrated with a database system and used. The simulation result of the model was used for predicting the dynamics and the possible outcomes and was used by the health authorities to decide on the measures to be taken in order to control the pandemic situation. The survival package was implemented in the programming language Java and the analytics were performed with R Studio. During the first run in March 2020, the simulation showed that without measures other than individual personal behavior and appropriate medication, the death toll would have been about 27 million people worldwide within the first year. The model predicted the hospitalization rates (standard and intensive care) for Tyrol and South Tyrol with an accuracy of about 1.5% average error. They were calculated to provide 10-days forecasts. The state government and the hospitals were provided with the 10-days models to support their decision-making. This ensured that standard care was maintained for as long as possible without restrictions. Furthermore, various measures were estimated and thereafter enforced. Among other things, communities were quarantined based on the calculations while, in accordance with the calculations, the curfews for the entire population were reduced. With this framework, which is used in the national crisis team of the Austrian province of Tyrol, a very accurate model could be created on the federal state level as well as on the district and municipal level, which was able to provide decision-makers with a solid information basis. This framework can be transferred to various infectious diseases and thus can be used as a basis for future monitoring.

Keywords: modelling, simulation, agent-based, SARS-Cov-2, COVID-19

Procedia PDF Downloads 147

Authors: Rami Hashish, Manon Limousis-Gayda, Caitlin H. McCleery

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Introduction: A leading cause of emergency room visits among youth (in the United States), is sports-related traumatic brain injuries. Mild traumatic brain injuries (mTBIs), also called concussions, are caused by linear and/or angular acceleration experienced at the head and represent an increasing societal burden. Due to the developing nature of the brain in youth, there is a great risk for long-term neuropsychological deficiencies following a concussion. Accordingly, the purpose of this paper is to investigate incidence rates of concussion across gender for the five most common youth sports in the United States. These include basketball, track and field, soccer, baseball (boys), softball (girls), football (boys), and volleyball (girls). Methods: A PubMed search was performed for four search themes combined. The first theme identified the outcomes (concussion, brain injuries, mild traumatic brain injury, etc.). The second theme identified the sport (American football, soccer, basketball, softball, volleyball, track, and field, etc.). The third theme identified the population (adolescence, children, youth, boys, girls). The last theme identified the study design (prevalence, frequency, incidence, prospective). Ultimately, 473 studies were surveyed, with 15 fulfilling the criteria: prospective study presenting original data and incidence of concussion in the relevant youth sport. The following data were extracted from the selected studies: population age, total study population, total athletic exposures (AE) and incidence rate per 1000 athletic exposures (IR/1000). Two One-Way ANOVA and a Tukey’s post hoc test were conducted using SPSS. Results: From the 15 selected studies, statistical analysis revealed the incidence of concussion per 1000 AEs across the considered sports ranged from 0.014 (girl’s track and field) to 0.780 (boy’s football). Average IR/1000 across all sports was 0.483 and 0.268 for boys and girls, respectively; this difference in IR was found to be statistically significant (p=0.013). Tukey’s post hoc test showed that football had significantly higher IR/1000 than boys’ basketball (p=0.022), soccer (p=0.033) and track and field (p=0.026). No statistical difference was found for concussion incidence between girls’ sports. Removal of football was found to lower the IR/1000 for boys without a statistical difference (p=0.101) compared to girls. Discussion: Football was the only sport showing a statistically significant difference in concussion incidence rate relative to other sports (within gender). Males were overall more likely to be concussed than females when football was included (1.8x), whereas concussion was more likely for females when football was excluded. While the significantly higher rate of concussion in football is not surprising because of the nature and rules of the sport, it is concerning that research has shown higher incidence of concussion in practices than games. Interestingly, findings indicate that girls’ sports are more concussive overall when football is removed. This appears to counter the common notion that boys’ sports are more physically taxing and dangerous. Future research should focus on understanding the concussive mechanisms of injury in each sport to enable effective rule changes.

Keywords: gender, football, soccer, traumatic brain injury

Procedia PDF Downloads 120

Authors: Sujoy Khan

Abstract:

There is a rising concern with increasing allergies affecting both adults and children in rural and urban India. Recent report on adults in a densely populated North Indian city showed sensitization rates for house dust mite, parthenium, and cockroach at 60%, 40% and 18.75% that is now comparable to allergy prevalence in cities in the United States. Data from patients residing in the eastern part of India is scarce. A retrospective study (over 2 years) was done on patients with allergic rhinitis and asthma where allergen-specific IgE levels were measured to see the aero-allergen sensitization pattern in a large metropolitan city of East India. Total IgE and allergen-specific IgE levels were measured using ImmunoCAP (Phadia 100, Thermo Fisher Scientific, Sweden) using region-specific aeroallergens: Dermatophagoides pteronyssinus (d1); Dermatophagoides farinae (d2); cockroach (i206); grass pollen mix (gx2) consisted of Cynodon dactylon, Lolium perenne, Phleum pratense, Poa pratensis, Sorghum halepense, Paspalum notatum; tree pollen mix (tx3) consisted of Juniperus sabinoides, Quercus alba, Ulmus americana, Populus deltoides, Prosopis juliflora; food mix 1 (fx1) consisted of Peanut, Hazel nut, Brazil nut, Almond, Coconut; mould mix (mx1) consisted of Penicillium chrysogenum, Cladosporium herbarum, Aspergillus fumigatus, Alternaria alternate; animal dander mix (ex1) consisted of cat, dog, cow and horse dander; and weed mix (wx1) consists of Ambrosia elatior, Artemisia vulgaris, Plantago lanceolata, Chenopodium album, Salsola kali, following manufacturer’s instructions. As the IgE levels were not uniformly distributed, median values were used to represent the data. 92 patients with allergic rhinitis and asthma (united airways disease) were studied over 2 years including 21 children (age < 12 years) who had total IgE and allergen-specific IgE levels measured. The median IgE level was higher in 2016 than in 2015 with 60% of patients (adults and children) being sensitized to house dust mite (dual positivity for Dermatophagoides pteronyssinus and farinae). Of 11 children in 2015, whose total IgE ranged from 16.5 to >5000 kU/L, 36% of children were polysensitized (≥4 allergens), and 55% were sensitized to dust mites. Of 10 children in 2016, total IgE levels ranged from 37.5 to 2628 kU/L, and 20% were polysensitized with 60% sensitized to dust mites. Mould sensitivity was 10% in both of the years in the children studied. A consistent finding was that ragweed sensitization (molecular homology to Parthenium hysterophorus) appeared to be increasing across all age groups, and throughout the year, as reported previously by us where 25% of patients were sensitized. In the study sample overall, sensitizations to dust mite, cockroach, and parthenium were important risks in our patients with moderate to severe asthma that reinforces the importance of controlling indoor exposure to these allergens. Sensitizations to dust mite, cockroach and parthenium allergens are important predictors of asthma morbidity not only among children but also among adults in Eastern India.

Keywords: aAeroallergens, asthma, dust mite, parthenium, rhinitis

Procedia PDF Downloads 170

Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

Procedia PDF Downloads 183