Search results for: admission delay

Authors: Bajraktarevic Adnan, Djukic Branka, Sporisevic Lutvo, Krdzalic Zecevic Belma, Uzicanin Sajra, Hadzimuratovic Admir, Hadzimuratovic Hadzipasic Emina, Abduzaimovic Alisa, Kustric Amer, Suljevic Ismet, Serafi Ismail, Tahmiscija Indira, Khatib Hakam, Semic Jusufagic Aida, Haas Helmut, Vladicic Aleksandra, Aplenc Richard, Kadic Deovic Aida

Abstract:

Introduction: Joubert syndrome has an autosomal recessive pattern of inheritance. It is referred as the brain malfunctioning and caused due to the underdevelopment of the cerebellar vermis. Associated conditions involving the eye, the kidney, and ocular disease are well described. Aims: Research helps us better understand this diseases, Joubert syndrome and can lead to advances in diagnosis and treatment. Methods: Different several conditions have been described in which the molar tooth sign and characteristics of Joubert syndrome in ten different places in the world. Carrier testing and diagnosis are available if one of these gene mutations has been identified in an affected family member. Results: Authors have described eleven cases during twenty years of Joubert syndrome. It is a clinically and genetically heterogeneous group of disorders characterized by hypoplasia of the cerebellar vermis with the characteristic neuroradiologic molar tooth sign, and accompanying neurologic symptoms, including dysregulation of breathing pattern and developmental delay. We made confirmation of diagnosis in twin sisters with Joubert syndrome with renal anomalies. Ocular symptoms have existed in seven cases (63.64%) from total eleven. Eleven cases were different sex, five boys (45.45%) and six girls (54.44%). Conclusions: Joubert syndrome is inherited as an autosomal recessive genetic disorder with several features of the disease.

Keywords: Joubert syndrome, cerebellooculorenal syndrome, autosomal recessive genetic disorder (ARGD), children

Procedia PDF Downloads 256

Authors: P. Uma Devi, S. Sujith, K. Rahul, T. S. Dipu, V. Anil Kumar , Vidya Menon

Abstract:

Introduction: Candida is an important cause of bloodstream infections (BSIs), causing significant mortality and morbidity. The epidemiology of Candida infection is also changing, mainly in relation to the number of episodes caused by species Candida non-albicans. However, in India, the true burden of candidemia is not clear. Thus, this study was conducted to evaluate the clinical characteristics, species distribution, antifungal susceptibility and outcome of candidemia at our hospital. Methodology: Between January 2012 and April 2014, adult patients with at least one positive blood culture for Candida species were identified through the microbiology laboratory database (for each patient only the first episode of candidemia was recorded). Patient data was collected by retrospective chart review of clinical characteristics including demographic data, risk factors; species distribution, resistance to antifungals and survival. Results: A total of 165 episodes of Candida BSI were identified, with 115 episodes occurring in adult patients. Most of the episodes occurred in males (69.6%). Nearly 82.6% patients were between 41 to 80 years and majority of the patients were in the intensive care unit (65.2%) at the time of diagnosis. On admission, 26.1% and 18.3% patients had pneumonia and urinary tract infection, respectively. Majority of the candidemia episodes were found in the general medicine department (23.5%) followed by gastrointestinal surgery (13.9%) and medical oncology & haematology (13%). Risk factors identified were prior hospitalization within one year (83.5%), antibiotic therapy within the last one month (64.3%), indwelling urinary catheter (63.5%), central venous catheter use (59.1%), diabetes mellitus (53%), severe sepsis (45.2%), mechanical ventilation (43.5%) and surgery (36.5%). C. tropicalis (30.4%) was the leading cause of infection followed by C. parapsilosis (28.7%) and C. albicans (13%). Other non-albicans species isolated included C. haemulonii (7.8%), C. glabrata (7%), C. famata (4.3%) and C. krusei (1.7%). Antifungal susceptibility to fluconazole was 87.9% (C. parapsilosis), 100% (C. tropicalis) and 93.3% (C. albicans). Mortality was noted in 51 patients (44.3%). Early mortality (within 7 days) was noted in 32 patients while late mortality (between 7 and 30 days) was noted in 19 patients. Conclusion: In recent years, candidemia has been flourishing in critically ill patients. Comparison of data from our own hospital from 2005 shows a doubling of the incidence. Rapid changes in the rate of infection, potential risk factors, and emergence of non-albicans Candida demand continued surveillance of this serious BSI. High index of suspicion and sensitive diagnostics are essential to improve outcomes in resource limited settings with emergence of non-albicans Candida.

Keywords: antifungal susceptibility, candida albicans, candidemia, non-albicans candida

Procedia PDF Downloads 431

Authors: Sridhar Rapuru, D. Mallikarjunreddy, Rajanarendra Sai

Abstract:

In this reign of the internet, the access of any multimedia file to the users at any time with a superior quality is needed. To achieve this goal, it is very important to have a good network without any interruptions between the satellites along with various earth stations. For that purpose, a high speed inter-satellite optical wireless communication system (IsOWC) is designed with space and polarization diversity techniques. IsOWC offers a high bandwidth, small size, less power requirement and affordable when compared with the present microwave satellite systems. To improve the efficiency and to reduce the propagation delay, inter-satellite link is established between the satellites. High accurate tracking systems are required to establish the reliable connection between the satellites as they have their own orbits. The only disadvantage of this IsOWC system is laser beam width is narrower than the RF because of this highly accurate tracking system to meet this requirement. The satellite uses the 'ephemerides data' for rough pointing and tracking system for fine pointing to the other satellite. In this proposed IsOWC system, laser light is used as a wireless connectedness between the source and destination and free space acts as the channel to carry the message. The proposed system will be designed, simulated and analyzed for 6000km with an improvement of data rate over previously existing systems. The performance parameters of the system are Q-factor, eye opening, bit error rate, etc., The proposed system for Inter-satellite Optical Wireless Communication System Design Using Diversity Techniques finds huge scope of applications in future generation communication purposes.

Keywords: inter-satellite optical wireless system, space and polarization diversity techniques, line of sight, bit error rate, Q-factor

Procedia PDF Downloads 237

Authors: Vipul M. Patel, Hemantkumar B. Mehta

Abstract:

Technological innovations in electronic world demand novel, compact, simple in design, less costly and effective heat transfer devices. Closed Loop Pulsating Heat Pipe (CLPHP) is a passive phase change heat transfer device and has potential to transfer heat quickly and efficiently from source to sink. Thermal performance of a CLPHP is governed by various parameters such as number of U-turns, orientations, input heat, working fluids and filling ratio. The present paper is an attempt to predict the thermal performance of a CLPHP using Artificial Neural Network (ANN). Filling ratio and heat input are considered as input parameters while thermal resistance is set as target parameter. Types of neural networks considered in the present paper are radial basis, generalized regression, linear layer, cascade forward back propagation, feed forward back propagation; feed forward distributed time delay, layer recurrent and Elman back propagation. Linear, logistic sigmoid, tangent sigmoid and Radial Basis Gaussian Function are used as transfer functions. Prediction accuracy is measured based on the experimental data reported by the researchers in open literature as a function of Mean Absolute Relative Deviation (MARD). The prediction of a generalized regression ANN model with spread constant of 4.8 is found in agreement with the experimental data for MARD in the range of ±1.81%.

Keywords: ANN models, CLPHP, filling ratio, generalized regression, spread constant

Procedia PDF Downloads 263

Authors: Zolani Metu

Abstract:

The death of more than 140 psychiatric patients who were unethically deinstitutionalized from the Life Esidimeni hospital Johannesburg, in 2016, shined a light on South Africa’s failing public mental healthcare system. Compounded by insufficient research evidence on African deinstitutionalization, this necessitates inquiries into deinstitutionalized mental healthcare, reintegration and community-based mental healthcare within the South African context. This study employed a quantitative research approach which utilized a cross-sectional research design, to investigate experiences with the reintegration of institutionalized forensic mental health service users into communities in the Western Cape, South Africa. A convenience sample of 100 mental health care workers from different occupational and organizational backgrounds in the Western Cape was purposively selected using the Western Cape Health Directorate as a sampling frame. A self-administered questionnaire (SAQ) was used as the data collection instrument. The results of the study indicate that criminogenic factors such as substance use, history of violent behaviour, criminal history and disruptive social behaviour complicate the reintegration of forensic mental health service users into communities. The current extent of reintegration of forensic mental health service users was found to be 'poor' (46%; n= 46); and financial difficulties, criminogenic factors and limited Community-Based Care (CBC) facilities were identified as key barriers to the reintegration process. 56% of all job applications for forensic mental health service users were unsuccessful, and 53% of all applications for their admission into CBC facilities were declined. Although social support (informal) was found to be essential for successful reintegration, institutional support (formal) through assertive community treatment (35%; n= 35) and CBC facilities (21%) and the disability grant (DG=50%) was found to be more important for family coping and reintegration. Moreover, 72% of respondents had positive perceptions about the process of reintegration; no statistically significant relationship was found between years of experience and perceptions about reintegration (P-value = 0.062); and perceptions were not found to be a barrier to reintegration. No statistically significant relationship was found between years of working experience and understanding the legislative framework of deinstitutionalization (P-Value =.0.061). However, using a Chi-square test, a significant relationship (P-value = 0.021) was found between sex and understanding the legal framework involved in the process of reintegration. The study recommends a post-2020 deinstitutionalization agenda that factors-in criminogenic realities associated with forensic mental health service users, and affirms the strengthening of PHC and community based care systems as precedents of successful deinstitutionalization and reintegration of mental health service users.

Keywords: forensic mental health, deinstitutionalization, reintegration, mental health service users

Procedia PDF Downloads 137

Authors: Esha Saha, Pradip Kumar Ray

Abstract:

A hospital inventory comprises of a large number and great variety of items for the proper treatment and care of patients, such as pharmaceuticals, medical equipment, surgical items, etc. Improper management of these items, i.e. stockouts, may lead to delay in treatment or other fatal consequences, even death of the patient. So, generally the hospitals tend to overstock items to avoid the risk of stockout which leads to unnecessary investment of money, difficulty in storing, more expiration and wastage, etc. Thus, in such challenging environment, it is necessary for hospitals to follow an inventory policy considering the stochasticity of demand in a hospital. Statistical analysis captures the correlation of patient condition based on bed occupancy with the patient demand which changes stochastically. Due to the dependency on bed occupancy, the markov model is developed that helps to map the changes in demand of hospital inventory based on the changes in the patient condition represented by the movements of bed occupancy states (acute care state, rehabilitative state and long-care state) during the length-of-stay of patient in a hospital. An inventory policy is developed for a hospital based on the fulfillment of patient demand with the objective of minimizing the frequency and quantity of placement of orders of inventoried items. The analytical structure of the model based on probability calculation is provided to show the optimal inventory-related decisions. A case-study is illustrated in this paper for the development of hospital inventory model based on patient demand for multiple inpatient pharmaceutical items. A sensitivity analysis is conducted to investigate the impact of inventory-related parameters on the developed optimal inventory policy. Therefore, the developed model and solution approach may help the hospital managers and pharmacists in managing the hospital inventory in case of stochastic demand of inpatient pharmaceutical items.

Keywords: bed occupancy, hospital inventory, markov model, patient condition, pharmaceutical items

Procedia PDF Downloads 298

Authors: Sabo Elizabeth

Abstract:

Electronic learning is increasingly popular learning approach in higher educational institutions due to vast growth of internet technology. This approach is important in human capital development. An investigation of open distance and e-learning facilities and information need by open and distance learning students was carried out in Jalingo, Nigeria. Structured questionnaires were administered to 70 registered ODL students of the NOUN. Information sourced from the respondents covered demographic, economic and institutional variables. Data collected for demographic variables were computed as frequency count and percentages. Assessment of the effectiveness of ODL facilities and information need among open and distance learning students was computed on a three or four point Likert Rating Scale. Findings indicated that there are more men compared to women. A large proportion of the respondents are married and there are more matured students in ODL compared to the youth. A high proportion of the ODL students obtained qualifications higher than the secondary school certificate. The proportion of computer literate ODL students was high, and large number of the students does not own a laptop computer. Inadequate e -books and reference materials, internet gadgets and inadequate books (hard copies) and reference material are factors that limit utilization of e-learning facilities in the study areas. Inadequate computer facilities and power back up caused inconveniences and delay in administering and use of e learning facilities. To a high extent, open and distance learning students needed information on university time table and schedule of activities, availability and access to books (hard and e-books) and reference materials. The respondents emphasized that contact with course coordinators via internet will provide a better learning and academic performance.

Keywords: open and distance learning, information required, electronic books, internet gadgets, Likert scale test

Procedia PDF Downloads 301

Authors: Vincent Jones

Abstract:

The North African country of Libya is in crisis and is currently a humanitarian disaster. The current American ‘hands off’ foreign policy appear to have contributed to this crisis. The research upon which this paper is based focused on a qualitative analysis of migration to Libya and its history with slavery, current conditions that have contributed to the re-emergence of slavery, an analysis of available resources in the effected region, and an analysis of legal remedies pursuant to international law. In addition, a qualitative analysis of American foreign policy from the Reagan Administration through the current Trump administration has been a focus of analysis. The major findings of this research are: (1) Since the removal of Muammar Gadhafi, a move that the United States played a major role in achieving, the nation of Libya has been in free fall and the rule of law has all but disappeared. As a major port stop for refugees and migrants fleeing atrocities in sub-Saharan African states, Libya has become the gate way to European ports of asylum. The problem is these migrant refugees are unwanted, caught between rival and often ineffective governments, profiteers, and inaction from the international community. (2) The outlook for these refugees is bleak: the ineffective government of Libya is ill-equipped to handle the large influx, European refugee destination states like Italy and Greece are already overburdened by the Syrian refugee crisis and are reluctant to accept more refugees, leaving the powerful and armed Libyan militia in control of a situation that is ripe for exploitation. (3) The combined intervention of the international community, led by a newly committed and engaged American foreign policy. In conclusion, a new American foreign policy approach along with the active engagement of the United Nations, EU, and the African Union can effectively resolve this humanitarian crisis.

Keywords: slavery, Libya, migrants, slave auction

Procedia PDF Downloads 207

Authors: Magdi Elmessiry, Adel Elmessiry

Abstract:

The fashion industry represents a significant portion of the global gross domestic product, however, it is plagued by cheap imitators that infringe on the trademarks which destroys the fashion industry's hard work and investment. While eventually the copycats would be found and stopped, the damage has already been done, sales are missed and direct and indirect jobs are lost. The infringer thrives on two main facts: the time it takes to discover them and the lack of tracking technologies that can help the consumer distinguish them. Blockchain technology is a new emerging technology that provides a distributed encrypted immutable and fault resistant ledger. Blockchain presents a ripe technology to resolve the infringement epidemic facing the fashion industry. The significance of the study is that a new approach leveraging the state of the art blockchain technology coupled with artificial intelligence is used to create a framework addressing the fashion infringement problem. It transforms the current focus on legal enforcement, which is difficult at best, to consumer awareness that is far more effective. The framework, Crypto CopyCat, creates an immutable digital asset representing the actual product to empower the customer with a near real time query system. This combination emphasizes the consumer's awareness and appreciation of the product's authenticity, while provides real time feedback to the producer regarding the fake replicas. The main findings of this study are that implementing this approach can delay the fake product penetration of the original product market, thus allowing the original product the time to take advantage of the market. The shift in the fake adoption results in reduced returns, which impedes the copycat market and moves the emphasis to the original product innovation.

Keywords: fashion, infringement, blockchain, artificial intelligence, textiles supply chain

Procedia PDF Downloads 235

Authors: Omojokun G. Aju, Adedayo O. Sule

Abstract:

ZigBee wireless sensor and control network is one of the most popularly deployed wireless technologies in recent years. This is because ZigBee is an open standard lightweight, low-cost, low-speed, low-power protocol that allows true operability between systems. It is built on existing IEEE 802.15.4 protocol and therefore combines the IEEE 802.15.4 features and newly added features to meet required functionalities thereby finding applications in wide variety of wireless networked systems. ZigBee‘s current focus is on embedded applications of general-purpose, inexpensive, self-organising networks which requires low to medium data rates, high number of nodes and very low power consumption such as home/industrial automation, embedded sensing, medical data collection, smart lighting, safety and security sensor networks, and monitoring systems. Although the ZigBee design specification includes security features to protect data communication confidentiality and integrity, however, when simplicity and low-cost are the goals, security is normally traded-off. A lot of researches have been carried out on ZigBee technology in which emphasis has mainly been placed on ZigBee network performance characteristics such as energy efficiency, throughput, robustness, packet delay and delivery ratio in different scenarios and applications. This paper investigate and analyse the data accuracy, network implementation difficulties and security challenges of ZigBee network applications in star-based and mesh-based topologies with emphases on its home monitoring application using the ZigBee ProBee ZE-10 development boards for the network setup. The paper also expose some factors that need to be considered when designing ZigBee network applications and suggest ways in which ZigBee network can be designed to provide more resilient to network attacks.

Keywords: home monitoring, IEEE 802.14.5, topology, wireless security, wireless sensor network (WSN), ZigBee

Procedia PDF Downloads 355

Authors: Mohanad Moustafa, Julia Sieberer, Rhys Davies

Abstract:

Background: Orbital compartment syndrome (OCS) is a sight-threatening Ophthalmologic emergency caused by rapidly increasing intraorbital pressure. It is usually caused by a retrobulbar hemorrhage as a result of trauma. If not treated in a timely manner, permanent vision loss can occur. Lateral canthotomy and cantholysis are minor procedures that can be performed bedside with equipment available in the emergency department. The aim of the procedure is to release the attachments between the suspensory ligaments of the eye and the bony orbital wall, leading to a decrease in intraorbital pressure and preventing irreversible loss of vision. As most Ophthalmologists across the UK provide non-resident on-call service, this may lead to a delay in the treatment of OCS and stresses the need for Emergency medical staff to be able to provide this sight-saving procedure independently. Aim: To survey current training, experience, and confidence levels among Emergency Medicine doctors in performing emergency lateral canthotomy and to establish whether these variables change the following teaching from experienced ophthalmologists. RESULTS: Most EM registrars had little to no experience in performing lateral canthotomy and cantholysis. The majority of them showed a significant increase in their confidence to perform the procedure following ophthalmic-led teaching. The survey also showed that the registrars felt such training should be added to/part of the EM curriculum. Conclusion: The involvement of Ophthalmologists in the teaching of EM doctors to recognise and treat OCS independently may prevent delays in treatment and reduce the risk of permanent sight loss. This project showed potential in improving patient care and will lead to a National Survey of EM doctors across the UK.

Keywords: lateral canthotomy, retrobulbar hemorrhage, Ophthalmology, orbital compartment syndrome, sight loss, blindness

Procedia PDF Downloads 76

Authors: Walid A. Attia, Taher M. Bazan, Fawzy Eltohamy, Mahmoud Fathy

Abstract:

System performance evaluation is an essential stage in the design of high-resolution satellite telescopes prior to the development process. In this paper, a system performance evaluation of a very high-resolution satellite telescope is investigated. The evaluated system has a Korsch optical scheme design. This design has been discussed in another paper with respect to three-mirror anastigmat (TMA) scheme design and the former configuration showed better results. The investigated system is based on the Korsch optical design integrated with a time-delay and integration charge coupled device (TDI-CCD) sensor to achieve a ground sampling distance (GSD) of 25 cm. The key performance metrics considered are the spatial resolution, the signal to noise ratio (SNR) and the total modulation transfer function (MTF) of the system. In addition, the national image interpretability rating scale (NIIRS) metric is assessed to predict the image quality according to the modified general image quality equation (GIQE). Based on the orbital, optical and detector parameters, the estimated GSD is found to be 25 cm. The SNR has been analyzed at different illumination conditions of target albedos, sun and sensor angles. The system MTF has been computed including diffraction, aberration, optical manufacturing, smear and detector sampling as the main contributors for evaluation the MTF. Finally, the system performance evaluation results show that the computed MTF value is found to be around 0.08 at the Nyquist frequency, the SNR value was found to be 130 at albedo 0.2 with a nadir viewing angles and the predicted NIIRS is in the order of 6.5 which implies a very good system image quality.

Keywords: modulation transfer function, national image interpretability rating scale, signal to noise ratio, satellite telescope performance evaluation

Procedia PDF Downloads 354

Authors: Alireza Taghdiri, Sara Ghanbarzade Ghomi

Abstract:

Existing buildings are permanently subjected to change, continuously renovated and repaired in their long service life. Old buildings are destroyed and their material and components are recycled or reused for constructing new ones. In this process, importance of sustainability principles for building construction is obviously known and great significance must be attached to consumption of resources, resulting effects on the environment and economic costs. Utilization strategies for extending buildings service life and delay in destroying have positive effect on environment protection. In addition, simpler alterability or expandability of buildings’ structures and reducing energy and natural resources consumption have benefits for users, producers and environment. To solve these problems, by applying theories of open building, structural components of some conventional building systems have been analyzed and then, a new geometry adaptive building system is developed which can transform and support different imposed loads. In order to achieve this goal, various research methods and tools such as professional and scientific literatures review, comparative analysis, case study and computer simulation were applied and data interpretation was implemented using descriptive statistics and logical arguments. Therefore, hypothesis and proposed strategies were evaluated and an adaptable and reusable 2-dimensional building system was presented which can respond appropriately to dwellers and end-users needs and provide reusability of structural components of building system in new construction or function. Investigations showed that this incremental building system can be successfully applied in achieving the architectural design objectives and by small modifications on components and joints, it is easy to obtain different and adaptable load-optimized component alternatives for flexible spaces.

Keywords: adaptability, durability, open building, service life, structural building system

Procedia PDF Downloads 539

Authors: R. M. Rajapaksa

Abstract:

Construction industry is one of the key players in driving the economy of a country to achieve its prosperity. However, a dispute is one of the crucial factors which prevent the completion of construction contracts within the budgeted cost, scheduled time, and accepted quality. Disputes are inevitable in the construction contract. Accordingly, a study has been undertaken to identify the factors affecting contractual disputes in construction projects in Sri Lanka. The study was a mixed approach with major qualitative and minor quantitative. Qualitative study was set in the form of in-depth interviews with eighteen participants, and quantitative study was conducted using a questionnaire with twenty-four respondents from previously implemented projects by the National Water Supply & Drainage Board representing the employer, engineer and the Contractor to identify the factors affecting contractual disputes and to verify most critical factors respectively. Data analysis for qualitative and quantitative studies was carried out by means of transcribing, code & categorizeand average score methods, respectively. The study reveals that there are forty factors affecting the contractual disputes in construction contracts in Sri Lanka. The finding further illustrates that conflicting decisions by inexperience personnel in the higher position of the Employer, ambiguities resulting inadequate descriptions of the preliminary/general items in price schedule, unfair valuation and late confirmation of variations, unfair determination due to lack of experience of the Engineer/Consultant, under certification of progress payments, unfair grant of EOT & application of delay damages, unreasonable claims for variation of works, errors/discrepancies/ambiguities in the contract conditions and discrepancies & errors in designs & specifications are the most critical factors affecting contractual disputes. Finally, the study proposed remedial measures to most critical factors affecting contractual disputes.

Keywords: dispute, contractual, factors, employer, engineer, contractor, construction projects

Procedia PDF Downloads 186

Authors: Pedro Batista, André Vinha, Filipe Castelo, Bárbara Costa, Ricardo Sousa, Raquel Ricardo, André Pinto

Abstract:

Background: Septic arthritis is a diagnosis that must be considered in any patient presenting with acute joint swelling and fever. Among the several risk factors for septic arthritis, such as age, rheumatoid arthritis, recent surgery, or skin infection, diabetes mellitus can sometimes be the main risk factor. Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, it is uncommon in monomicrobial necrotizing fasciitis. Objectives: A case report of concomitant septic arthritis and necrotizing fasciitis in a patient with undiagnosed diabetes based on clinical history. Study Design & Methods: We report a case of a 58-year-old Portuguese previously healthy man who presented to the emergency department with fever and left knee swelling and pain for two days. The blood work revealed ketonemia of 6.7 mmol/L and glycemia of 496 mg/dL. The vital signs were significant for a temperature of 38.5 ºC and 123 bpm of heart rate. The left knee had edema and inflammatory signs. Computed tomography of the left knee showed diffuse edema of the subcutaneous cellular tissue and soft tissue air bubbles. A diagnosis of septic arthritis and necrotising fasciitis was made. He was taken to the operating room for surgical debridement. The samples collected intraoperatively were sent for microbiological analysis, revealing infection by multi-sensitive Staphylococcus aureus. Given this result, the empiric flucloxacillin (500 mg IV) and clindamycin (1000 mg IV) were maintained for 3 weeks. On the seventh day of hospitalization, there was a significant improvement in subcutaneous and musculoskeletal tissues. After two weeks of hospitalization, there was no purulent content and partial closure of the wounds was possible. After 3 weeks, he was switched to oral antibiotics (flucloxacillin 500 mg). A week later, a urinary infection by Pseudomonas aeruginosa was diagnosed and ciprofloxacin 500 mg was administered for 7 days without complications. After 30 days of hospital admission, the patient was discharged home and recovered. Results: The final diagnosis of concomitant septic arthritis and necrotizing fasciitis was made based on the imaging findings, surgical exploration and microbiological tests results. Conclusions: Early antibiotic administration and surgical debridement are key in the management of septic arthritis and necrotizing fasciitis. Furthermore, risk factors control (euglycemic blood glucose levels) must always be taken into account given the crucial role in the patient's recovery.

Keywords: septic arthritis, Necrotizing fasciitis, diabetes, Staphylococcus Aureus

Procedia PDF Downloads 279

Authors: Alireza Taghdiri, Sara Ghanbarzade Ghomi

Abstract:

Existing buildings are permanently subjected to change, continuously renovated and repaired in their long service life. Old buildings are destroyed and their material and components are recycled or reused for constructing new ones. In this process, importance of sustainability principles for building construction is obviously known and great significance must be attached to consumption of resources, resulting effects on the environment and economic costs. Utilization strategies for extending buildings service life and delay in destroying have positive effect on environment protection. In addition, simpler alterability or expandability of buildings’ structures and reducing energy and natural resources consumption have benefits for users, producers and environment. To solve these problems, by applying theories of open building, structural components of some conventional building systems have been analyzed and then, a new geometry adaptive building system is developed which can transform and support different imposed loads. In order to achieve this goal, various research methods and tools such as professional and scientific literatures review, comparative analysis, case study and computer simulation were applied and data interpretation was implemented using descriptive statistics and logical arguments. Therefore, hypothesis and proposed strategies were evaluated and an adaptable and reusable 2-dimensional building system was presented which can respond appropriately to dwellers and end-users needs and provide reusability of structural components of building system in new construction or function. Investigations showed that this incremental building system can be successfully applied in achieving the architectural design objectives and by small modifications on components and joints, it is easy to obtain different and adaptable load-optimized component alternatives for flexible spaces.

Keywords: adaptability, durability, open building, service life, structural building system

Procedia PDF Downloads 329

Authors: Gabriel Sepulveda Navarro

Abstract:

Traditional interventions for young offenders are necessary but not sufficient to tackle the multiple causes of juvenile crime. For instance, interventions offered to young offenders often are verbally mediated and dialogue based, requiring important metacognitive abilities as well as abstract thinking, assuming average performance in a wide variety of skills. It seems necessary to assess a broader set of abilities and functions in order to increase the efficiency of interventions while addressing offending. In order to clarify these assumptions, Stroop Test, as well as Rey-Osterrieth Complex Figure Test were applied to juvenile offenders tried and sentenced for violent crimes in Santiago de Chile. A random sample was drawn from La Cisterna Half-Open Program, consisting of 50 young males between 18 and 24 years old, residing in different districts of Santiago de Chile. The analysis of results suggests a disproportionately elevated incidence of impairments in executive functions and visuospatial skills. As an outcome, over 40% of the sample shows a significant low performance in both assessments, exceeding four times the same prevalence rates among young people in the general population. While executive functions entail working memory (being able to keep information and use it in some way), cognitive flexibility (to think about something in more than one way) and inhibitory control (being able to self-control, ignore distractions and delay immediate gratification), visuospatial skills permit to orientate and organize a planned conduct. All of these abilities are fundamental to the skill of avoiding violent behaviour and abiding by social rules. Understanding the relevance of neurodevelopmental impairments in the onset of violent and criminal behaviour, as well as recidivism, eventually may guide the deployment of a more comprehensive assessment and treatment for juvenile offenders.

Keywords: executive functions, half-open program, juvenile offenders, neurodisabilities, visuospatial skills

Procedia PDF Downloads 128

Authors: J. H. Park, R. H. Hwang, K. B. Yi

Abstract:

Carbon Capture and Storage (CCS) is one of the important technology to reduce the CO₂ emission from large stationary sources such as a power plant. Among the carbon technologies for power plants, chemical looping combustion (CLC) has attracted much attention due to a higher thermal efficiency and a lower cost of electricity. A CLC process is consists of a fuel reactor and an air reactor which are interconnected fluidized bed reactor. In the fuel reactor, an oxygen carrier (OC) is reduced by fuel gas such as CH₄, H₂, CO. And the OC is send to air reactor and oxidized by air or O₂ gas. The oxidation and reduction reaction of OC occurs between the two reactors repeatedly. In the CLC system, high concentration of CO₂ can be easily obtained by steam condensation only from the fuel reactor. It is very important to understand the oxidation and reduction characteristics of oxygen carrier in the CLC system to determine the solids circulation rate between the air and fuel reactors, and the amount of solid bed materials. In this study, we have conducted the experiment and interpreted oxidation and reduction reaction characteristics via observing weight change of Ni-based oxygen carrier using the TGA with varying as concentration and temperature. Characterizations of the oxygen carrier were carried out with BET, SEM. The reaction rate increased with increasing the temperature and increasing the inlet gas concentration. We also compared experimental results and adapted basic reaction kinetic model (JMA model). JAM model is one of the nucleation and nuclei growth models, and this model can explain the delay time at the early part of reaction. As a result, the model data and experimental data agree over the arranged conversion and time with overall variance (R²) greater than 98%. Also, we calculated activation energy, pre-exponential factor, and reaction order through the Arrhenius plot and compared with previous Ni-based oxygen carriers.

Keywords: chemical looping combustion, kinetic, nickel-based, oxygen carrier, spray drying method

Procedia PDF Downloads 182

Authors: Swati Kapoor, Rajeev Upreti, Monica Mahajan, Abhaya Indrayan, Dinesh Srivastava

Abstract:

Enteric Fever is caused by gram negative bacilli Salmonella typhi and paratyphi. It is associated with high morbidity and mortality worldwide. Timely initiation of treatment is a crucial step for prevention of any complications. Cultures of body fluids are diagnostic, but not always conclusive or practically feasible in most centers. Moreover, the results of cultures delay the treatment initiation. Serological tests lack diagnostic value. The blood counts can offer a promising option in diagnosis. A retrospective study to find out the relevance of leucopenia and eosinopenia was conducted on 203 culture proven enteric fever patients and 159 culture proven non-enteric fever patients in a tertiary care hospital in New Delhi. The patient details were retrieved from the electronic medical records section of the hospital. Absolute eosinopenia was considered as absolute eosinophil count (AEC) of less than 40/mm³ (normal level: 40-400/mm³) using LH-750 Beckman Coulter Automated machine. Leucopoenia was defined as total leucocyte count (TLC) of less than 4 X 10⁹/l. Blood cultures were done using BacT/ALERT FA plus automated blood culture system before first antibiotic dose was given. Case and control groups were compared using Pearson Chi square test. It was observed that absolute eosinophil count (AEC) of 0-19/mm³ was a significant finding (p < 0.001) in enteric fever patients, whereas leucopenia was not a significant finding (p=0.096). Using Receiving Operating Characteristic (ROC) curves, it was observed that patients with both AEC < 14/mm³ and TCL < 8 x 10⁹/l had 95.6% chance of being diagnosed as enteric fever and only 4.4% chance of being diagnosed as non-enteric fever. This result was highly significant with p < 0.001. This is a very useful association of AEC and TLC found in enteric fever patients of this study which can be used for the early initiation of treatment in clinically suspected enteric fever patients.

Keywords: absolute eosinopenia, absolute eosinophil count, enteric fever, leucopenia, total leucocyte count

Procedia PDF Downloads 148

Authors: Pornpote Nusen, Manop Kaewmoracharoen

Abstract:

In recent years, there was an observable shift in fully developed countries from constructing new buildings to modifying existing buildings. The issue was that although an effective instrument like BIM (Building Information Modeling) was well developed for constructing new buildings, it was not widely used to renovate old buildings. BIM was accepted as an effective means to overcome common managerial problems such as project delay, cost overrun, and poor quality of the project life cycle. It was recently introduced in Thailand and rarely used in a renovation project. Today, in Thailand, BIM is mostly used for creating aesthetic 3D models and quantity takeoff purposes, though it can be an effective tool to use as a project management tool in planning and scheduling. Now the governmental sector in Thailand begins to recognize the uses of using BIM to manage a construction project, but the knowledge about the BIM implementation to governmental construction projects is underdeveloped. Further studies need to be conducted to maximize its advantages for the governmental sector. An educational extra large governmental building of 17,000 square-meters was used in this research. It is currently under construction for a two-year renovation project. BIM models of the building for the exterior and interior areas were created for the whole five floors. Then 4D BIM with combination of 3D BIM plus time was created for planning and scheduling. Three focus groups had been done with executive committee, contractors, and officers of the building to discuss the possibility of usage and usefulness of BIM approach over the traditional process. Several aspects were discussed in the positive sides, especially several foreseen problems, such as the inadequate accessibility of ways, the altered ceiling levels, the impractical construction plan created through a traditional approach, and the lack of constructability information. However, for some parties, the cost of BIM implementation was a concern, though, this study believes, its uses outweigh the cost.

Keywords: building information modeling, extra large building, governmental building renovation, project management, renovation, 4D BIM

Procedia PDF Downloads 126

Authors: Revathi S. Rajan, Pratibha Malik, Nupur Garg, Smitha Avula, Kamini A. Rao

Abstract:

This study aimed to analyse the pregnancy outcomes in patients with TPO positivity after appropriate L-Thyroxin supplementation with close surveillance. All pregnant women attending the antenatal clinic at Milann-The Fertility Center, Bangalore, India- from Aug 2013 to Oct 2014 whose booking TSH was more than 2.5 mIU/L were included along with those pregnant women with prior hypothyroidism who were TPO positive. Those with TPO positive status were vigorously managed with appropriate thyroxin supplementation and the doses were readjusted every 3 to 4 weeks until delivery. Women with recurrent pregnancy loss were also tested for TPO positivity and if tested positive, were monitored serially with TSH and fT4 levels every 3 to 4 weeks and appropriately supplemented with thyroxin when the levels fluctuated. The testing was done after an informed consent in all these women. The statistical software namely SAS 9.2, SPSS 15.0, Stata 10.1, MedCalc 9.0.1, Systat 12.0 and R environment ver.2.11.1 were used for the analysis of the data. 460 pregnant women were screened for thyroid dysfunction at booking of which 52% were hypothyroid. Majority of them (31.08%) were subclinically hypothyroid and the remaining were overt. 25% of the total no. of patients screened were TPO positive. The various pregnancy complications that were observed in the TPO positive women were gestational glucose intolerance [60%], threatened abortion [21%], midtrimester abortion [4.3%], premature rupture of membranes [4.3%], cervical funneling [4.3%] and fetal growth restriction [3.5%]. 95.6% of the patients who followed up till the end delivered beyond 30 weeks. 42.6% of these patients had previous history of recurrent abortions or adverse obstetric outcome and 21.7% of the delivered babies required NICU admission. Obstetric outcomes in our study in terms of midtrimester abortions, placental abruption, and preterm delivery improved for the better after close monitoring of the thyroid hormone [TSH and fT4] levels every 3 to 4 weeks with appropriate dose adjustment throughout pregnancy. Euthyroid women with TPO positive status enrolled in the study incidentally were those with recurrent abortions/infertility and required thyroxin supplements due to elevated Thyroid hormone (TSH, fT4) levels during the course of their pregnancy. Significant associations were found with age>30 years and Hyperhomocysteinemia [p=0.017], recurrent pregnancy loss or previous adverse obstetric outcomes [p=0.067] and APLA [p=0.029]. TPO antibody levels >600 I U/ml were significantly associated with development of gestational hypertension [p=0.041] and fetal growth restriction [p=0.082]. Euthyroid women with TPO positivity were also screened periodically to counter fluctuations of the thyroid hormone levels with appropriate thyroxin supplementation. Thus, early identification along with aggressive management of thyroid dysfunction and stratification of these patients based on their TPO status with appropriate thyroxin supplementation beginning in the first trimester will aid risk modulation and also help avert complications.

Keywords: TPO antibody, subclinical hypothyroidism, anti nuclear antibody, thyroxin

Procedia PDF Downloads 299

Authors: Alireza Taghdiri, Sara Ghanbarzade Ghomi

Abstract:

Existing buildings are permanently subjected to change, continuously renovated and repaired in their long service life. Old buildings are destroyed and their material and components are recycled or reused for constructing new ones. In this process, the importance of sustainability principles for building construction is obviously known and great significance must be attached to the consumption of resources, resulting effects on the environment and economic costs. Utilization strategies for extending buildings service life and delay in destroying have a positive effect on environment protection. In addition, simpler alterability or expandability of buildings’ structures and reducing energy and natural resources consumption have benefits for users, producers and the environment. To solve these problems, by applying theories of open building, structural components of some conventional building systems have been analyzed and then, a new geometry adaptive building system is developed which can transform and support different imposed loads. In order to achieve this goal, various research methods and tools such as professional and scientific literatures review, comparative analysis, case study and computer simulation were applied and data interpretation was implemented using descriptive statistics and logical arguments. Therefore, hypothesis and proposed strategies were evaluated and an adaptable and reusable 2-dimensional building system was presented which can respond appropriately to dwellers and end-users needs and provide reusability of structural components of building system in new construction or function. Investigations showed that this incremental building system can be successfully applied in achieving the architectural design objectives and by small modifications on components and joints, it is easy to obtain different and adaptable load-optimized component alternatives for flexible spaces.

Keywords: adaptability, durability, open building, service life, structural building system

Procedia PDF Downloads 403

Authors: Pushp Lata Sankhwar

Abstract:

INTRODUCTION: Maternal Hypothyroidism is the most frequent endocrine disorder in pregnancy and varies from 2.5% in the west to 11.0% in India. Maternal Hypothyroidism can have detrimental maternal effects like increased risk of preterm labor, PPROM leading to increased maternal morbidity and also on the neonate in the form of prematurity and its complications, prolonged hospital stay, neurological developmental problems, delayed milestones and mental retardation etc. Henceforth, the study was planned to evaluate the role of Hypothyroidism in preterm labor and its effect on neonates. AIMS AND OBJECTIVES: To Correlate Overt Hypothyroidism, Subclinical Hypothyroidism and Isolated Hypothyroxinemia With Preterm Labor and the neonatal outcome. Material and Methods: A case-control study of singleton pregnancy was performed over a year, in which a total of 500 patients presenting in the emergency with preterm labor were enrolled. The thyroid profile of these patients was sent at the time of admission, on the basis of which they were divided into Cases – Hypothyroidic mothers and Controls – Euthyroid mothers. The cases were further divided into subclinical, overt Hypothyroidism and isolated hypothyroxinemia. The neonatal outcome of these groups was also compared on the basis of the incidence and severity of neonatal morbidity, neonatal respiratory distress, the incidence of neonatal Hypothyroidism and early complications. The feto-maternal data was collected and analysed. RESULTS: In the study, a total of 500 antenatal patients with a history of preterm labor were enrolled, out of which 67 (13.8%) patients were found to be hypothyroid. The majority of the mothers had Subclinical Hypothyroidism (12.2%), followed by Overt Hypothyroidism seen in 1% of the mothers and isolated hypothyroxinemia in 0.6% of cases. The neonates of hypothyroid mothers had higher levels of cord blood TSH, and the mean cord blood TSH levels were highest in the case of neonates of mothers with Overt Hypothyroidism. The need for resuscitation of the neonates at the time of birth was higher in the case of neonates of hypothyroid mothers, especially with Subclinical Hypothyroidism. Also, it was found that the requirement of oxygen therapy in the form of oxygen by nasal prongs, oxygen by a hood, CPAP, CPAP along with surfactant therapy and mechanical ventilation along with surfactant therapy was significantly higher in the case of neonates of hypothyroid mothers. CONCLUSION: The results of our study imply that uncontrolled and untreated maternal Hypothyroidism may also lead to preterm delivery. The neonates of mothers with Hypothyroidism have higher cord blood TSH levels. The study also shows that there is an increased incidence and severity of respiratory distress in the neonates of hypothyroid mothers with untreated subclinical Hypothyroidism. Hence, we propose that routine screening for thyroid dysfunction in pregnant women should be done to prevent thyroid-related feto-maternal complications.

Keywords: high-risk pregnancy, thyroid, dysfunction, hypothyroidism, Preterm labor

Procedia PDF Downloads 53

Authors: Jeong-Moh John Yahng, Angelika Na

Abstract:

Introduction: Increasing numbers of general surgical patients are being prescribed antiplatelet and anticoagulant medications (APAC) for various cardiovascular and cerebrovascular conditions. Surgical patients who are on APAC present a management challenge as bleeding risk needs to be balanced with thromboembolic risk. Although guidelines exist in regards to APAC management in elective surgery, there is a lack of guidelines in the emergency surgery setting. In this study we aim to characterise APAC usage in emergency general surgical patients admitted to a rural hospital. We also assess the impact of APAC usage on clinical management of these patients. Methods: Prospective study of emergency general surgical admissions at Northeast Health Wangaratta (Victoria) from 2 July to 25 Oct 2014. Questionnaire collected demographics data, admission diagnosis, APAC usage, anaesthesia techniques, operation types, transfusion requirement and morbidity / mortality data. Results: During the 4 month study, 118 patients were classified into two groups: non-APAC (n=96, 81%) and APAC (n=22, 19%). Patients in the APAC group were older compared to the non-APAC patients (mean age 72 vs 42 years old). Amongst patients younger than 60 years old, only 1% of them were on APAC. In contrast, 49% of patients older than 60 years old were on APAC (p<0.001). Patients who were admitted with a bleeding problem were more likely to be on APAC (p<0.05). 19% of emergency general surgery patients were on APAC. The majority (91%) of them were on antiplatelet medication, with two patients being on dual antiplatelet agents (aspirin + clopidogrel or ticagrelor). 15% of emergency general surgical patients requiring operations were on APAC. 11% of all laparotomies and 33% of gastroscopy for haematemesis/melaena patients were on APAC. Both of the patients operated for bleeding following surgery at another hospital were in the APAC group. In regards to impact on clinical management, 59% of APAC patients had their medications interrupted or ceased, on average by 3.5 days (range 1-13 days). 2 out of 75 operations were delayed due to APAC usage. There was no difference in the use of central venous or arterial line for increased monitoring (p=0.14) or in the use of warming blanket (Bair Hugger™) (p=0.94). Overall, transfusion rate was higher amongst APAC patients (14% vs 3%) (p 0.04). The recorded morbidity (n=2) and mortality (n=1) in this study were all in the APAC group. Discussion: Nineteen percent of emergency general surgical admissions and fifteen percent of operated patients were on APAC. The prevalence of APAC usage was higher in those aged sixty and above. General surgical patients who were admitted with a bleeding problem were more likely to be on APAC. Two patients who were operated for bleeding following surgery at another hospital were in the APAC group. Note that there was no patient in the non-APAC group who was admitted for post-operative bleeding. We observed two cases in which operation was delayed due to APAC usage. Transfusion, morbidity and mortality rate were higher in the APAC group. Conclusion: In this study, nineteen percent of emergency general surgical admissions were on APAC. The use of APAC is more prevalent in the older age group, particularly those aged sixty and above. Higher proportion of APAC compared to non-APAC patients were admitted and operated for bleeding problems. There is an urgent need for clinical guidelines regarding APAC management in emergency general surgical patients.

Keywords: antiplatelet, anticoagulants, emergency general surgery, rural general surgery, morbidity, mortality

Procedia PDF Downloads 113

Authors: Dilshad Ali Mohammed, Ziyad Nayef Shamsulddin Aldoski, Millet Salim Mohammed

Abstract:

The increase in levels of traffic congestion along urban signalized arterials needs efficient traffic management. The application of traffic signal coordination can improve the traffic operation and safety for a series of signalized intersection along the arterials. The objective of this study is to evaluate the benefits achievable through actuated traffic signal coordination and make a comparison in control delay against the same signalized intersection in case of being isolated. To accomplish this purpose, a series of eight signalized intersections located on two major arterials in Duhok City was chosen for conducting the study. Traffic data (traffic volumes, link and approach speeds, and passenger car equivalent) were collected at peak hours. Various methods had been used for collecting data such as video recording technique, moving vehicle method and manual methods. Geometric and signalization data were also collected for the purpose of the study. The coupling index had been calculated to check the coordination attainability, and then time space diagrams were constructed representing one-way coordination for the intersections on Barzani and Zakho Streets, and others represented two-way coordination for the intersections on Zakho Street with accepted progression bandwidth efficiency. The results of this study show great progression bandwidth of 54 seconds for east direction coordination and 17 seconds for west direction coordination on Barzani Street under suggested controlled speed of 60 kph agreeable with the present data. For Zakho Street, the progression bandwidth is 19 seconds for east direction coordination and 18 seconds for west direction coordination under suggested controlled speed of 40 kph. The results show that traffic signal coordination had led to high reduction in intersection control delays on both arterials.

Keywords: bandwidth, congestion, coordination, traffic, signals, streets

Procedia PDF Downloads 267

Authors: Vidhi Chandra, Arshpreet Singh Grewal

Abstract:

A five-year-old male child born from non-consanguineous marriage, who presented with complaints of growth retardation and no appreciable increase in the penile size since birth and he was posted for de-gloving of penis with dissection of corpora under anaesthesia. After thorough preoperative evaluation it was revealed that patient had peculiar facial dysmorphism that of Robinow Syndrome, high arched palate, Mallampati grade III, mesomelic limbs, scoliotic spine and short stature. All routine investigation were within normal limit, electrocardiography (ECG) and 2D-Echocardiography (ECHO) were normal. In antero-posterior roentgenogram chest showed butterfly and hemivertebrae at multiple levels. The patient was considered to be ASA II. On the day of surgery after ensuring fasting of 6 hours, patient was taken in operation theatre, all standard ASA monitoring was done with ECG, non-invasive blood pressure, peripheral oxygen saturation (SpO2) and body temperature. The patient was pre-oxygenated with 100% oxygen with anatomical face mask. General anaesthesia was induced with Sevoflurane 1-8%, and airway was secured with an appropriate size supraglottic airway and anaesthesia was maintained with nitrous oxide and oxygen in 1:1 ratio along with sevoflurane 2%. An ultrasound guided caudal block was given owing to the skeletal deformities making it difficult even under USG guidance. Post operatively patient was given supportive care with proper hydration, antibiotics, anti-inflammatory and analgesics. He was discharged the next day and followed up weekly for a month. DISCUSSION Robinow syndrome is genetically inherited as autosomal dominant, autosomal recessive or heterogenous disorder involving tyrosine kinase ROR2 gene located on chromosome 9. It has low incidence with no preponderance for any gender. Though intelligence is normal but developmental delay and mental retardation occurs in 20%cases

Keywords: Robinow Syndrome, dwarfism, paediatric, anaesthesia

Procedia PDF Downloads 83

Authors: Takaaki Nemoto

Abstract:

Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

Procedia PDF Downloads 129

Authors: Younes El Khchine, Mohammed Sriti

Abstract:

A parametric study has been conducted to analyse the flow around S809 airfoil of a wind turbine in order to better understand the characteristics and effects of laminar separation bubble (LSB) on aerodynamic design for maximizing wind turbine efficiency. Numerical simulations were performed at low Reynolds numbers by solving the Unsteady Reynolds Averaged Navier-Stokes (URANS) equations based on C-type structural mesh and using the γ-Reθt turbulence model. A two-dimensional study was conducted for the chord Reynolds number of 1×10⁵ and angles of attack (AoA) between 0 and 20.15 degrees. The simulation results obtained for the aerodynamic coefficients at various angles of attack (AoA) were compared with XFoil results. A sensitivity study was performed to examine the effects of Reynolds number and free-stream turbulence intensity on the location and length of the laminar separation bubble and the aerodynamic performances of wind turbines. The results show that increasing the Reynolds number leads to a delay in the laminar separation on the upper surface of the airfoil. The increase in Reynolds number leads to an accelerated transition process, and the turbulent reattachment point moves closer to the leading edge owing to an earlier reattachment of the turbulent shear layer. This leads to a considerable reduction in the length of the separation bubble as the Reynolds number is increased. The increase in the level of free-stream turbulence intensity leads to a decrease in separation bubble length and an increase in the lift coefficient while having negligible effects on the stall angle. When the AoA increased, the bubble on the suction airfoil surface was found to move upstream to the leading edge of the airfoil, that causes earlier laminar separation.

Keywords: laminar separation bubble, turbulence intensity, S809 airfoil, transition model, Reynolds number

Procedia PDF Downloads 46

Authors: Kavita Khoiwal, Vatsla Dadhwal, K. Aparna Sharma, Dipika Deka, Plabani Sarkar

Abstract:

Introduction: About 2.4 million (1.93 - 3.04 million) people are living with HIV/AIDS in India. Of all HIV infections, 39% (9,30,000) are among women. 5.4% of infections are from mother to child transmission (MTCT), 25,000 infected children are born every year. Besides the risk of mother to child transmission of HIV, these women are at risk of the higher adverse pregnancy outcome. The objectives of the study were to compare the obstetric and neonatal outcome in women who are HIV positive with low-risk HIV negative women and effect of antiretroviral drugs on preterm birth and IUGR. Materials and Methods: This is a retrospective case record analysis of 212 HIV-positive women delivering between 2002 to 2015, in a tertiary health care centre which was compared with 238 HIV-negative controls. Women who underwent medical termination of pregnancy and abortion were excluded from the study. Obstetric outcome analyzed were pregnancy induced hypertension, HIV positive intrauterine growth restriction, preterm birth, anemia, gestational diabetes and intrahepatic cholestasis of pregnancy. Neonatal outcome analysed were birth weight, apgar score, NICU admission and perinatal transmission.HIV-positiveOut of 212 women, 204 received antiretroviral therapy (ART) to prevent MTCT, 27 women received single dose nevirapine (sdNVP) or sdNVP tailed with 7 days of zidovudine and lamivudine (ZDV + 3TC), 15 received ZDV, 82 women received duovir and 80 women received triple drug therapy depending upon the time period of presentation. Results: Mean age of 212 HIV positive women was 25.72+3.6 years, 101 women (47.6 %) were primigravida. HIV positive status was diagnosed during pregnancy in 200 women while 12 women were diagnosed prior to conception. Among 212 HIV positive women, 20 (9.4 %) women had preterm delivery (< 37 weeks), 194 women (91.5 %) delivered by cesarean section and 18 women (8.5 %) delivered vaginally. 178 neonates (83.9 %) received exclusive top feeding and 34 neonates (16.03 %) received exclusive breast feeding. When compared to low risk HIV negative women (n=238), HIV positive women were more likely to deliver preterm (OR 1.27), have anemia (OR 1.39) and intrauterine growth restriction (OR 2.07). Incidence of pregnancy induced hypertension, diabetes mellitus and ICP was not increased. Mean birth weight was significantly lower in HIV positive women (2593.60+499 gm) when compared to HIV negative women (2919+459 gm). Complete follow up is available for 148 neonates till date, rest are under evaluation. Out of these 7 neonates found to have HIV positive status. Risk of preterm birth (P value = 0.039) and IUGR (P value = 0.739) was higher in HIV positive women who did not receive any ART during pregnancy than women who received ART. Conclusion: HIV positive pregnant women are at increased risk of adverse pregnancy outcome. Multidisciplinary team approach and use of highly active antiretroviral therapy can optimize the maternal and perinatal outcome.

Keywords: antiretroviral therapy, HIV infection, IUGR, preterm birth

Procedia PDF Downloads 240

Authors: C. W. F. Che Wan Putra, M. Alshawi, M. S. Al Ahbabi, M. Jabakhanji

Abstract:

The construction industry is a multi-disciplinary and multi-national industry, which has an important role to play within the overall economy of any country. There are major challenges to an improved performance within the industry. Particularly lacking is, the ability to capture the large amounts of information generated during the life-cycle of projects and to make these available, in the right format, so that professionals can then evaluate alternative solutions based on life-cycle analysis. The fragmented nature of the industry is the main reason behind the unavailability and ill utilisation of project information. The lack of adequately engaging clients and managing their requirements contributes adversely to construction budget and schedule overruns. This is a difficult task to achieve, particularly if clients are not continuously and formally involved in the design and construction process, which means that the design intent is left to designers that may not always satisfy clients’ requirements. Client lead is strongly recognised in bringing change through better collaboration between project stakeholders. However, one of the major challenges is that collaboration is operated under conventional procurement methods, which hugely limit the stakeholders’ roles and responsibilities to bring about the required level of collaboration. A research has been conducted with a typical project in the UAE. A qualitative research work was conducted including semi-structured interviews with project partners to discover the real reasons behind this delay. The case study also investigated the real causes of the problems and if they can be adequately addressed by BIM and IPD. Special focus was also placed on the Client leadership and the role the Client can play to eliminate/minimize these problems. It was found that part of the ‘key elements’ from which the problems exist can be attributed to the client leadership and the collaborative environment and BIM.

Keywords: client leadership, building information modelling (BIM), integrated project delivery (IPD), case study

Procedia PDF Downloads 300