Search results for: atmospheric distillation unit
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 2929

Search results for: atmospheric distillation unit

349 The Impact of Streptococcus pneumoniae Colonization on Viral Bronchiolitis

Authors: K. Genise, S. Murthy

Abstract:

Introductory Statement: The results of this retrospective chart review suggest the effects of bacterial colonization in critically ill children with viral bronchiolitis, currently unproven, are clinically insignificant. Background: Viral bronchiolitis is one of the most prevalent causes of illness requiring hospitalization among children worldwide and one of the most common reasons for admission to pediatric intensive care. It has been hypothesized that co-infection with bacteria results in more severe clinical outcomes. Conversely, the effects of bacterial colonization in critically ill patients with bronchiolitis are poorly defined. Current clinical management of colonized patients consists primarily of supportive therapies with the role of antibiotics remaining controversial. Methods: A retrospective review of all critically ill children admitted to the BC Children’s Hospital Pediatric Intensive Care Unit (PICU) from 2014-2017 with a diagnosis of bronchiolitis was performed. Routine testing in this time frame consisted of complete pathogen testing, including PCR for Streptococcus pneumoniae. Analyses were performed to determine the impact of bacterial colonization and antibiotic use on a primary outcome of PICU length-of-stay, with secondary outcomes of hospital length-of-stay and duration of ventilation. Results: There were 92 patients with complete pathogen testing performed during the assessed timeframe. A comparison between children with detected Streptococcus pneumoniae (n=22) and those without (n=70) revealed no significant (p=0.20) differences in severity of illness on presentation as per Pediatric Risk of Mortality III scores (mean=3.0). Patients colonized with S. pneumoniae had significantly shorter PICU stays (p=0.002), hospital stays (p=0.0001) and duration of non-invasive ventilation (p=0.002). Multivariate analyses revealed that these effects on length of PICU stay and duration of ventilation do not persist after controlling for antibiotic use, presence of radiographic consolidation, age, and severity of illness (p=0.15, p=0.32). The relationship between colonization and duration of hospital stay persists after controlling for these variables (p=0.008). Conclusions: Children with viral bronchiolitis colonized with S. pneumoniae do not appear to have significantly different PICU length-of-stays or duration of ventilation compared to children who are not colonized. Colonized children appear to have shorter hospital stays. The results of this study suggest bacterial colonization is not associated with increased severity of presenting illness or negative clinical outcomes.

Keywords: bronchiolitis, colonization, critical care, pediatrics, pneumococcal, infection

Procedia PDF Downloads 489
348 The Implementation of a Nurse-Driven Palliative Care Trigger Tool

Authors: Sawyer Spurry

Abstract:

Problem: Palliative care providers at an academic medical center in Maryland stated medical intensive care unit (MICU) patients are often referred late in their hospital stay. The MICU has performed well below the hospital quality performance metric of 80% of patients who expire with expected outcomes should have received a palliative care consult within 48 hours of admission. Purpose: The purpose of this quality improvement (QI) project is to increase palliative care utilization in the MICU through the implementation of a Nurse-Driven PalliativeTriggerTool to prompt the need for specialty palliative care consult. Methods: MICU nursing staff and providers received education concerning the implications of underused palliative care services and the literature data supporting the use of nurse-driven palliative care tools as a means of increasing utilization of palliative care. A MICU population specific criteria of palliative triggers (Palliative Care Trigger Tool) was formulated by the QI implementation team, palliative care team, and patient care services department. Nursing staff were asked to assess patients daily for the presence of palliative triggers using the Palliative Care Trigger Tool and present findings during bedside rounds. MICU providers were asked to consult palliative medicinegiven the presence of palliative triggers; following interdisciplinary rounds. Rates of palliative consult, given the presence of triggers, were collected via electronic medical record e-data pull, de-identified, and recorded in the data collection tool. Preliminary Results: Over 140 MICU registered nurses were educated on the palliative trigger initiative along with 8 nurse practitioners, 4 intensivists, 2 pulmonary critical care fellows, and 2 palliative medicine physicians. Over 200 patients were admitted to the MICU and screened for palliative triggers during the 15-week implementation period. Primary outcomes showed an increase in palliative care consult rates to those patients presenting with triggers, a decreased mean time from admission to palliative consult, and increased recognition of unmet palliative care needs by MICU nurses and providers. Conclusions: Anticipatory findings of this QI project would suggest a positive correlation between utilizing palliative care trigger criteria and decreased time to palliative care consult. The direct outcomes of effective palliative care results in decreased length of stay, healthcare costs, and moral distress, as well as improved symptom management and quality of life (QOL).

Keywords: palliative care, nursing, quality improvement, trigger tool

Procedia PDF Downloads 161
347 Experimental Study on Bending and Torsional Strength of Bulk Molding Compound Seat Back Frame Part

Authors: Hee Yong Kang, Hyeon Ho Shin, Jung Cheol Yoo, Il Taek Lee, Sung Mo Yang

Abstract:

Lightweight technology using composites is being developed for vehicle seat structures, and its design must meet the safety requirements. According to the Federal Motor Vehicle Safety Standard (FMVSS) 207 seating systems test procedure, the back moment load is applied to the seat back frame structure for the safety evaluation of the vehicle seat. The seat back frame using the composites is divided into three parts: upper part frame, and left- and right-side frame parts following the manufacturing process. When a rear moment load is applied to the seat back frame, the side frame receives the bending load and the torsional load at the same time. This results in the largest loaded strength. Therefore, strength test of the component unit is required. In this study, a component test method based on the FMVSS 207 seating systems test procedure was proposed for the strength analysis of bending load and torsional load of the automotive Bulk Molding Compound (BMC) Seat Back Side Frame. Moreover, strength evaluation according to the carbon band reinforcement was performed. The back-side frame parts of the seat that are applied to the test were manufactured through BMC that is composed of vinyl ester Matrix and short carbon fiber. Then, two kinds of reinforced and non-reinforced parts of carbon band were formed through a high-temperature compression molding process. In addition, the structure that is applied to the component test was constructed by referring to the FMVSS 207. Then, the bending load and the torsional load were applied through the displacement control to perform the strength test for four load conditions. The results of each test are shown through the load-displacement curves of the specimen. The failure strength of the parts caused by the reinforcement of the carbon band was analyzed. Additionally, the fracture characteristics of the parts for four strength tests were evaluated, and the weakness structure of the back-side frame of the seat structure was confirmed according to the test conditions. Through the bending and torsional strength test methods, we confirmed the strength and fracture characteristics of BMC Seat Back Side Frame according to the carbon band reinforcement. And we proposed a method of testing the part strength of a seat back frame for vehicles that can meet the FMVSS 207.

Keywords: seat back frame, bending and torsional strength, BMC (Bulk Molding Compound), FMVSS 207 seating systems

Procedia PDF Downloads 186
346 The Impact of Roof Thermal Performance on the Indoor Thermal Comfort in a Natural Ventilated Building Envelope in Hot Climatic Climates

Authors: J. Iwaro, A. Mwasha, K. Ramsubhag

Abstract:

Global warming has become a threat of our time. It poses challenges to the existence of beings on earth, the built environment, natural environment and has made a clear impact on the level of energy and water consumption. As such, increase in the ambient temperature increases indoor and outdoor temperature level of the buildings which brings about the use of more energy and mechanical air conditioning systems. In addition, in view of the increased modernization and economic growth in the developing countries, a significant amount of energy is being used, especially those with hot climatic conditions. Since modernization in developing countries is rising rapidly, more pressure is being placed on the buildings and energy resources to satisfy the indoor comfort requirements. This paper presents a sustainable passive roof solution as a means of reducing energy cooling loads for satisfying human comfort requirements in a hot climate. As such, the study based on the field study data discusses indoor thermal roof design strategies for a hot climate by investigating the impacts of roof thermal performance on indoor thermal comfort in naturally ventilated building envelope small scaled structures. In this respect, the traditional concrete flat roof, corrugated galvanised iron roof and pre-painted standing seam roof were used. The experiment made used of three identical small scale physical models constructed and sited on the roof of a building at the University of the West Indies. The results show that the utilization of insulation in traditional roofing systems will significantly reduce heat transfer between the internal and ambient environment, thus reducing the energy demand of the structure and the relative carbon footprint of a structure per unit area over its lifetime. Also, the application of flat slab concrete roofing system showed the best performance as opposed to the metal roof sheeting alternative systems. In addition, it has been shown experimentally through this study that a sustainable passive roof solution such as insulated flat concrete roof in hot dry climate has a better cooling strength that can provide building occupant with a better thermal comfort, conducive indoor conditions and energy efficiency.

Keywords: building envelope, roof, energy consumption, thermal comfort

Procedia PDF Downloads 246
345 Fillet Chemical Composition of Sharpsnout Seabream (Diplodus puntazzo) from Wild and Cage-Cultured Conditions

Authors: Oğuz Taşbozan, Celal Erbaş, Şefik Surhan Tabakoğlu, Mahmut Ali Gökçe

Abstract:

Polyunsaturated fatty acids (PUFAs) and particularly the levels and ratios of ω-3 and ω-6 fatty acids are important for biological functions in humans and recognized as essential components of human diet. According to the terms of many different points of view, the nutritional composition of fish in culture conditions and caught from wild are wondered by the consumers. Therefore the aim of this study was to investigate the chemical composition of cage-cultured and wild sharpsnout seabream which has been preferred by the consumers as an economical important fish species in Turkey. The fish were caught from wild and obtained from cage-cultured commercial companies. Eight fish were obtained for each group, and their average weights of the samples were 245.8±13.5 g for cultured, 149.4±13.3 g for wild samples. All samples were stored in freezer (-18 °C) and analyses were carried out in triplicates, using homogenized boneless fish fillets. Proximate compositions (protein, ash, moisture and lipid) were determined. The fatty acid composition was analyzed by a GC Clarous 500 with auto sampler (Perkin–Elmer, USA). Proximate compositions of cage-cultured and wild samples of sharpsnout seabream were found statistical differences in terms of proximate composition between the groups. The saturated fatty acid (SFA), monounsaturated fatty acid (MUFA) and PUFA amounts of cultured and wild sharpsnout seabream were significantly different. ω3/ω6 ratio was higher in the cultured group. Especially in protein level and lipid level of cultured samples was significantly higher than wild counterparts. One of the reasons for this, cultured species exposed to continuous feeding. This situation had a direct effect on their body lipid content. The fatty acid composition of fish differs depending on a variety of factors including species, diet, environmental factors and whether they are farmed or wild. The higher levels of MUFA in the cultured fish may be explained with the high content of monoenoic fatty acids in the feed of cultured fish as in some other species. The ω3/ω6 ratio is a good index for comparing the relative nutritional value of fish oils. In our study, the cultured sharpsnout seabream appears to be better nutritious in terms of ω3/ω6. Acknowledgement: This work was supported by the Scientific Research Project Unit of the University of Cukurova, Turkey under grant no FBA-2016-5780.

Keywords: Diplodus puntazo, cage cultured, PUFA, fatty acid

Procedia PDF Downloads 234
344 Economic Analysis of a Carbon Abatement Technology

Authors: Hameed Rukayat Opeyemi, Pericles Pilidis Pagone Emmanuele, Agbadede Roupa, Allison Isaiah

Abstract:

Climate change represents one of the single most challenging problems facing the world today. According to the National Oceanic and Administrative Association, Atmospheric temperature rose almost 25% since 1958, Artic sea ice has shrunk 40% since 1959 and global sea levels have risen more than 5.5cm since 1990. Power plants are the major culprits of GHG emission to the atmosphere. Several technologies have been proposed to reduce the amount of GHG emitted to the atmosphere from power plant, one of which is the less researched Advanced zero-emission power plant. The advanced zero emission power plants make use of mixed conductive membrane (MCM) reactor also known as oxygen transfer membrane (OTM) for oxygen transfer. The MCM employs membrane separation process. The membrane separation process was first introduced in 1899 when Walter Hermann Nernst investigated electric current between metals and solutions. He found that when a dense ceramic is heated, the current of oxygen molecules move through it. In the bid to curb the amount of GHG emitted to the atmosphere, the membrane separation process was applied to the field of power engineering in the low carbon cycle known as the Advanced zero emission power plant (AZEP cycle). The AZEP cycle was originally invented by Norsk Hydro, Norway and ABB Alstom power (now known as Demag Delaval Industrial turbomachinery AB), Sweden. The AZEP drew a lot of attention because its ability to capture ~100% CO2 and also boasts of about 30-50% cost reduction compared to other carbon abatement technologies, the penalty in efficiency is also not as much as its counterparts and crowns it with almost zero NOx emissions due to very low nitrogen concentrations in the working fluid. The advanced zero emission power plants differ from a conventional gas turbine in the sense that its combustor is substituted with the mixed conductive membrane (MCM-reactor). The MCM-reactor is made up of the combustor, low-temperature heat exchanger LTHX (referred to by some authors as air preheater the mixed conductive membrane responsible for oxygen transfer and the high-temperature heat exchanger and in some layouts, the bleed gas heat exchanger. Air is taken in by the compressor and compressed to a temperature of about 723 Kelvin and pressure of 2 Mega-Pascals. The membrane area needed for oxygen transfer is reduced by increasing the temperature of 90% of the air using the LTHX; the temperature is also increased to facilitate oxygen transfer through the membrane. The air stream enters the LTHX through the transition duct leading to inlet of the LTHX. The temperature of the air stream is then increased to about 1150 K depending on the design point specification of the plant and the efficiency of the heat exchanging system. The amount of oxygen transported through the membrane is directly proportional to the temperature of air going through the membrane. The AZEP cycle was developed using the Fortran software and economic analysis was conducted using excel and Matlab followed by optimization case study. The Simple bleed gas heat exchange layout (100 % CO2 capture), Bleed gas heat exchanger layout with flue gas turbine (100 % CO2 capture), Pre-expansion reheating layout (Sequential burning layout)–AZEP 85% (85% CO2 capture) and Pre-expansion reheating layout (Sequential burning layout) with flue gas turbine–AZEP 85% (85% CO2 capture). This paper discusses monte carlo risk analysis of four possible layouts of the AZEP cycle.

Keywords: gas turbine, global warming, green house gas, fossil fuel power plants

Procedia PDF Downloads 367
343 Depositional Environment and Diagenetic Alterations, Influences of Facies and Fine Kaolinite Formation Migration on Sandstones’ Reservoir Quality, Sarir Formation, Sirt Basin Libya

Authors: Faraj M. Elkhatri, Hana Ali Allafi

Abstract:

The spatial and temporal distribution of diagenetic alterations related impact on the reservoir quality of the Sarir Formation. (present day burial depth of about 9000 feet) Depositional facies and diagenetic alterations are the main controls on reservoir quality of Sarir Formation Sirt Ba-sin Libya; these based on lithology and grain size as well as authigenic clay mineral types and their distributions. However, petrology investigation obtained on study area with five sandstone wells concentrated on main rock components and the parameters that may have impacts on reservoirs. the main authigenic clay minerals are kaolinite and dickite, these investigations have confirmed by X.R.D analysis and clay fraction. mainly Kaolinite and Dickite were extensively presented on all of wells with high amounts. As well as trace of detrital smectite and less amounts of illitized mud-matrix are possibly find by SEM image. Thin layers of clay presented as clay-grain coatings in local depth interpreted as remains of dissolved clay matrix is partly transformed into kaolinite adjacent and towards pore throat. This also may have impacts on most of the pore throats of this sandstone which are open and relatively clean with some of fine martial have been formed on occluded pores. This material is identified by EDS analysis to be collections of not only kaolinite booklets, but also small, disaggregated kaolinite platelets derived from the dis-aggregation of larger kaolinite booklets. These patches of kaolinite not only fill this pore, but also coat some of the sur-rounding framework grains. Quartz grains often enlarged by authigenic quartz overgrowths partially occlude and re-duce porosity. Scanning Electron Microscopy with Energy Dispersive Spectroscopy (SEM) was conducted on the post-test samples to examine any mud filtrate particles that may be in the pore throats. Semi-qualitative elemental data on select-ed minerals observed during the SEM study were obtained using an Energy Dispersive Spectroscopy (EDS) unit. The samples showed mostly clean open pore throats, with limited occlusion by kaolinite.

Keywords: por throat, formation damage, porosity lose, solids plugging

Procedia PDF Downloads 36
342 A Simulation-Based Investigation of the Smooth-Wall, Radial Gravity Problem of Granular Flow through a Wedge-Shaped Hopper

Authors: A. F. Momin, D. V. Khakhar

Abstract:

Granular materials consist of particulate particles found in nature and various industries that, due to gravity flow, behave macroscopically like liquids. A fundamental industrial unit operation is a hopper with inclined walls or a converging channel in which material flows downward under gravity and exits the storage bin through the bottom outlet. The simplest form of the flow corresponds to a wedge-shaped, quasi-two-dimensional geometry with smooth walls and radially directed gravitational force toward the apex of the wedge. These flows were examined using the Mohr-Coulomb criterion in the classic work of Savage (1965), while Ravi Prakash and Rao used the critical state theory (1988). The smooth-wall radial gravity (SWRG) wedge-shaped hopper is simulated using the discrete element method (DEM) to test existing theories. DEM simulations involve the solution of Newton's equations, taking particle-particle interactions into account to compute stress and velocity fields for the flow in the SWRG system. Our computational results are consistent with the predictions of Savage (1965) and Ravi Prakash and Rao (1988), except for the region near the exit, where both viscous and frictional effects are present. To further comprehend this behaviour, a parametric analysis is carried out to analyze the rheology of wedge-shaped hoppers by varying the orifice diameter, wedge angle, friction coefficient, and stiffness. The conclusion is that velocity increases as the flow rate increases but decreases as the wedge angle and friction coefficient increase. We observed no substantial changes in velocity due to varying stiffness. It is anticipated that stresses at the exit result from the transfer of momentum during particle collisions; for this reason, relationships between viscosity and shear rate are shown, and all data are collapsed into a single curve. In addition, it is demonstrated that viscosity and volume fraction exhibit power law correlations with the inertial number and that all the data collapse into a single curve. A continuum model for determining granular flows is presented using empirical correlations.

Keywords: discrete element method, gravity flow, smooth-wall, wedge-shaped hoppers

Procedia PDF Downloads 58
341 Common Caper (Capparis Spinosa L.) From Oblivion and Neglect to the Interface of Medicinal Plants

Authors: Ahmad Alsheikh Kaddour

Abstract:

Herbal medicine has been a long-standing phenomenon in Arab countries since ancient times because of its breadth and moderate temperament. Therefore, it possesses a vast natural and economic wealth of medicinal and aromatic herbs. This prompted ancient Egyptians and Arabs to discover and exploit them. The economic importance of the plant is not only from medicinal uses; it is a plant of high economic value for its various uses, especially in food, cosmetic and aromatic industries. It is also an ornamental plant and soil stabilization. The main objective of this research is to study the chemical changes that occur in the plant during the growth period, as well as the production of plant buds, which were previously considered unwanted plants. The research was carried out in the period 2021-2022 in the valley of Al-Shaflah (common caper), located in Qumhana village, 7 km north of Hama Governorate, Syria. The results of the research showed a change in the percentage of chemical components in the plant parts. The ratio of protein content and the percentage of fatty substances in fruits and the ratio of oil in the seeds until the period of harvesting of these plant parts improved, but the percentage of essential oils decreased with the progress of the plant growth, while the Glycosides content where improved with the plant aging. The production of buds is small, with dimensions as 0.5×0.5 cm, which is preferred for commercial markets, harvested every 2-3 days in quantities ranging from 0.4 to 0.5 kg in one cut/shrubs with 3 years’ age as average for the years 2021-2022. The monthly production of a shrub is between 4-5 kg per month. The productive period is 4 months approximately. This means that the seasonal production of one plant is 16-20 kg and the production of 16-20 tons per year with a plant density of 1,000 shrubs per hectare, which is the optimum rate of cultivation in the unit of mass, given the price of a kg of these buds is equivalent to 1 US $; however, this means that the annual output value of the locally produced hectare ranges from 16,000 US $ to 20,000 US $ for farmers. The results showed that it is possible to transform the cultivation of this plant from traditional random to typical areas cultivation, with a plant density of 1,000-1,100 plants per hectare according to the type of soil to obtain production of medicinal and nutritious buds, as well as, the need to pay attention to this national wealth and invest in the optimal manner, which leads to the acquisition of hard currency through export to support the national income.

Keywords: common caper, medicinal plants, propagation, medical, economic importance

Procedia PDF Downloads 43
340 Exploring the Correlation between Body Constitution of an Individual as Per Ayurveda and Gut Microbiome in Healthy, Multi Ethnic Urban Population in Bangalore, India

Authors: Shalini TV, Gangadharan GG, Sriranjini S Jaideep, ASN Seshasayee, Awadhesh Pandit

Abstract:

Introduction: Prakriti (body-mind constitution of an individual) is a conventional, customized and unique understanding of which is essential for the personalized medicine described in Ayurveda, Indian System of Medicine. Based on the Doshas( functional, bio humoral unit in the body), individuals are categorized into three major Prakriti- Vata, Pitta, and Kapha. The human gut microbiome hosts plenty of highly diverse and metabolically active microorganisms, mainly dominated by the bacteria, which are known to influence the physiology of an individual. Few researches have shown the correlation between the Prakriti and the biochemical parameters. In this study, an attempt was made to explore any correlation between the Prakriti (phenotype of an individual) with the Genetic makeup of the gut microbiome in healthy individuals. Materials and methods: 270 multi-ethnic, healthy volunteers of both sex with the age group between 18 to 40 years, with no history of antibiotics in the last 6 months were recruited into three groups of Vata, Pitta, and Kapha. The Prakriti of the individual was determined using Ayusoft, a software designed by CDAC, Pune, India. The volunteers were subjected to initial screening for the assessment of their height, weight, Body Mass Index, Vital signs and Blood investigations to ensure they are healthy. The stool and saliva samples of the recruited volunteers were collected as per the standard operating procedure developed, and the bacterial DNA was isolated using Qiagen kits. The extracted DNA was subjected to 16s rRNA sequencing using the Illumina kits. The sequencing libraries are targeting the variable V3 and V4 regions of the 16s rRNA gene. Paired sequencing was done on the MiSeq system and data were analyzed using the CLC Genomics workbench 11. Results: The 16s rRNA sequencing of the V3 and V4 regions showed a diverse pattern in both the oral and stool microbial DNA. The study did not reveal any specific pattern of bacterial flora amongst the Prakriti. All the p-values were more than the effective alpha values for all OTUs in both the buccal cavity and stool samples. Therefore, there was no observed significant enrichment of an OTU in the patient samples from either the buccal cavity or stool samples. Conclusion: In healthy volunteers of multi-ethnicity, due to the influence of the various factors, the correlation between the Prakriti and the gut microbiome was not seen.

Keywords: gut microbiome, ayurveda Prakriti, sequencing, multi-ethnic urban population

Procedia PDF Downloads 107
339 The Economic Burden of Mental Disorders: A Systematic Review

Authors: Maria Klitgaard Christensen, Carmen Lim, Sukanta Saha, Danielle Cannon, Finley Prentis, Oleguer Plana-Ripoll, Natalie Momen, Kim Moesgaard Iburg, John J. McGrath

Abstract:

Introduction: About a third of the world’s population will develop a mental disorder over their lifetime. Having a mental disorder is a huge burden in health loss and cost for the individual, but also for society because of treatment cost, production loss and caregivers’ cost. The objective of this study is to synthesize the international published literature on the economic burden of mental disorders. Methods: Systematic literature searches were conducted in the databases PubMed, Embase, Web of Science, EconLit, NHS York Database and PsychInfo using key terms for cost and mental disorders. Searches were restricted to 1980 until May 2019. The inclusion criteria were: (1) cost-of-illness studies or cost-analyses, (2) diagnosis of at least one mental disorder, (3) samples based on the general population, and (4) outcome in monetary units. 13,640 publications were screened by their title/abstract and 439 articles were full-text screened by at least two independent reviewers. 112 articles were included from the systematic searches and 31 articles from snowball searching, giving a total of 143 included articles. Results: Information about diagnosis, diagnostic criteria, sample size, age, sex, data sources, study perspective, study period, costing approach, cost categories, discount rate and production loss method and cost unit was extracted. The vast majority of the included studies were from Western countries and only a few from Africa and South America. The disorder group most often investigated was mood disorders, followed by schizophrenia and neurotic disorders. The disorder group least examined was intellectual disabilities, followed by eating disorders. The preliminary results show a substantial variety in the used perspective, methodology, costs components and outcomes in the included studies. An online tool is under development enabling the reader to explore the published information on costs by type of mental disorder, subgroups, country, methodology, and study quality. Discussion: This is the first systematic review synthesizing the economic cost of mental disorders worldwide. The paper will provide an important and comprehensive overview over the economic burden of mental disorders, and the output from this review will inform policymaking.

Keywords: cost-of-illness, health economics, mental disorders, systematic review

Procedia PDF Downloads 98
338 A Practical Approach Towards Disinfection Challenges in Sterile Manufacturing Area

Authors: Doris Lacej, Eni Bushi

Abstract:

Cleaning and disinfection procedures are essential for maintaining the cleanliness status of the pharmaceutical manufacturing environment particularly of the cleanrooms and sterile unit area. The Good Manufacturing Practice (GMP) Annex 1 recommendation highly requires the implementation of the standard and validated cleaning and disinfection protocols. However, environmental monitoring has shown that even a validated cleaning method with certified agents may result in the presence of atypical microorganisms’ colony that exceeds GMP limits for a specific cleanroom area. In response to this issue, this case study aims to arrive at the root cause of the microbial contamination observed in the sterile production environment in Profarma pharmaceutical industry in Albania through applying a problem-solving practical approach that ensures the appropriate sterility grade. The guidelines and literature emphasize the importance of several factors in the prevention of possible microbial contamination occurring in cleanrooms, grade A and C. These factors are integrated into a practical framework, to identify the root cause of the presence of Aspergillus Niger colony in the sterile production environment in Profarma pharmaceutical industry in Albania. In addition, the application of a semi-automatic disinfecting system such as H2O2 FOG into sterile grade A and grade C cleanrooms has been an effective solution in eliminating the atypical colony of Aspergillus Niger. Selecting the appropriate detergents and disinfectants at the right concentration, frequency, and combination; the presence of updated and standardized guidelines for cleaning and disinfection as well as continuous training of operators on these practices in accordance with the updated GMP guidelines are some of the identified factors that influence the success of achieving sterility grade. However, to ensure environmental sustainability it is important to be prepared for identifying the source of contamination and making the appropriate decision. The proposed case-based practical approach may help pharmaceutical companies to achieve sterile production and cleanliness environmental sustainability in challenging situations. Apart from the integration of valid agents and standardized cleaning and disinfection protocols according to GMP Annex 1, pharmaceutical companies must be careful and investigate the source and all the steps that can influence the results of an abnormal situation. Subsequently apart from identifying the root cause it is important to solve the problem with a successful alternative approach.

Keywords: cleanrooms, disinfectants, environmental monitoring, GMP Annex 1

Procedia PDF Downloads 188
337 The Impact of the Variation of Sky View Factor on Landscape Degree of Enclosure of Urban Blue and Green Belt

Authors: Yi-Chun Huang, Kuan-Yun Chen, Chuang-Hung Lin

Abstract:

Urban Green Belt and Blue is a part of the city landscape, it is an important constituent element of the urban environment and appearance. The Hsinchu East Gate Moat is situated in the center of the city, which not only has a wealth of historical and cultural resources, but also combines the Green Belt and the Blue Belt qualities at the same time. The Moat runs more than a thousand meters through the vital Green Belt and the Blue Belt in downtown, and each section is presented in different qualities of moat from south to north. The water area and the green belt of surroundings are presented linear and banded spread. The water body and the rich diverse river banks form an urban green belt of rich layers. The watercourse with green belt design lets users have connections with blue belts in different ways; therefore, the integration of Hsinchu East Gate and moat have become one of the unique urban landscapes in Taiwan. The study is based on the fact-finding case of Hsinchu East Gate Moat where situated in northern Taiwan, to research the impact between the SVF variation of the city and spatial sequence of Urban Green Belt and Blue landscape and visual analysis by constituent cross-section, and then comparing the influence of different leaf area index – the variable ecological factors to the degree of enclosure. We proceed to survey the landscape design of open space, to measure existing structural features of the plant canopy which contain the height of plants and branches, the crown diameter, breast-height diameter through access to diagram of Geographic Information Systems (GIS) and on-the-spot actual measurement. The north and south districts of blue green belt areas are divided 20 meters into a unit from East Gate Roundabout as the epicenter, and to set up a survey points to measure the SVF above the survey points; then we proceed to quantitative analysis from the data to calculate open landscape degree of enclosure. The results can be reference for the composition of future river landscape and the practical operation for dynamic space planning of blue and green belt landscape.

Keywords: sky view factor, degree of enclosure, spatial sequence, leaf area indices

Procedia PDF Downloads 527
336 Comprehensive Geriatric Assessments: An Audit into Assessing and Improving Uptake on Geriatric Wards at King’s College Hospital, London

Authors: Michael Adebayo, Saheed Lawal

Abstract:

The Comprehensive Geriatric Assessment (CGA) is the multidimensional tool used to assess elderly, frail patients either on admission to hospital care or at a community level in primary care. It is a tool designed with the aim of using a holistic approach to managing patients. A Cochrane review of CGA use in 2011 found that the likelihood of being alive and living in their own home rises by 30% post-discharge. RCTs have also discovered 10–15% reductions in readmission rates and reductions in institutionalization, and resource use and costs. Past audit cycles at King’s College Hospital, Denmark Hill had shown inconsistent evidence of CGA completion inpatient discharge summaries (less than 50%). Junior Doctors in the Health and Ageing (HAU) wards have struggled to sustain the efforts of past audit cycles due to the quick turnover in staff (four-month placements for trainees). This 7th cycle created a multi-faceted approach to solving this problem amongst staff and creating lasting change. Methods: 1. We adopted multidisciplinary team involvement to support Doctors. MDT staff e.g. Nurses, Physiotherapists, Occupational Therapists and Dieticians, were actively encouraged to fill in the CGA document. 2. We added a CGA Document Pro-forma to “Sunrise EPR” (Trust computer system). These CGAs were to automatically be included the discharge summary. 3. Prior to assessing uptake, we used a spot audit questionnaire to assess staff awareness/knowledge of what a CGA was. 4. We designed and placed posters highlighting domains of CGA and MDT roles suited to each domain on geriatric “Health and Ageing Wards” (HAU) in the hospital. 5. We performed an audit of % discharge summaries which include CGA and MDT role input. 6. We nominated ward champions on each ward from each multidisciplinary specialty to monitor and encourage colleagues to actively complete CGAs. 7. We initiated further education of ward staff on CGA's importance by discussion at board rounds and weekly multidisciplinary meetings. Outcomes: 1. The majority of respondents to our spot audit were aware of what a CGA was, but fewer had used the EPR document to complete one. 2. We found that CGAs were not being commenced for nearly 50% of patients discharged on HAU wards and the Frailty Assessment Unit.

Keywords: comprehensive geriatric assessment, CGA, multidisciplinary team, quality of life, mortality

Procedia PDF Downloads 61
335 Mobilizing Resources for Social Entrepreneurial Opportunity: A Framework of Engagement Strategy

Authors: Balram Bhushan

Abstract:

The emergence of social entrepreneurship challenges the strict categorization of not-for-profit, for-profit and hybrid organizations. Although the blurring of boundaries helps social entrepreneurial organizations (SEOs) make better use of emerging opportunities, it poses a significant challenge while mobilizing money from different sources. Additionally, for monetary resources, the legal framework of the host country may further complicate the issue by imposing strict accounting standards. Under such circumstances, the resource providers fail to recognize the suitable engagement strategy with the SEO of their choice. Based on the process of value creation and value capture, this paper develops a guiding framework for resource providers to design an appropriate mix of engagement with the identified SEOs. Essentially, social entrepreneurship creates value at the societal level, but value capture is a characteristic of an organization. Additionally, SEOs prefer value creation over value capture. The paper argued that the nature of the relationship between value creation and value capture determines the extent of blurred boundaries of the organization. Accordingly, synergistic, antagonistic and sequential relationships were proposed between value capture and value creation. When value creation is synergistically associated with value creation, the preferred nature of such action falls within the nature of for-profit organizations within the strictest legal framework. Banks offering micro-loans are good examples of this category. Opposite to this, the antagonist relationship between value creation and value capture, where value capture opportunities are sacrificed for value creation, dictates non-profit organizational structure. Examples of this category include non-government organizations and charity organizations. Finally, the sequential relationship between value capture opportunities is followed for value creation opportunities and guides the action closer to the hybrid structure. Examples of this category include organizations where a non-for-profit unit controls for-profit units of the organization either legally or structurally. As an SEO may attempt to utilize multiple entrepreneurial opportunities falling across any of the three relationships between value creation and value capture, the resource providers need to evaluate an appropriate mix of these relationships before designing their engagement strategies. The paper suggests three guiding principles for the engagement strategy. First, the extent of investment should be proportional to the synergistic relationship between value capture and value creation. Second, the subsidized support should be proportional to the sequential relationship. Finally, the funding (charity contribution) should be proportional to the antagonistic relationship. Finally, the resource providers are needed to keep a close watch on the evolving relationship between value creation and value capture for introducing appropriate changes in their engagement strategy.

Keywords: social entrepreneurship, value creation, value capture, entrepreneurial opportunity

Procedia PDF Downloads 101
334 Determination of Identification and Antibiotic Resistance Rates of Serratia marcescens and Providencia Spp. from Various Clinical Specimens by Using Both the Conventional and Automated (VITEK2) Methods

Authors: Recep Keşli, Gülşah Aşık, Cengiz Demir, Onur Türkyılmaz

Abstract:

Objective: Serratia species are identified as aerobic, motile Gram negative rods. The species Serratia marcescens (S. marcescens) causes both opportunistic and nosocomial infections. The genus Providencia is Gram-negative bacilli and includes urease-producing that is responsible for a wide range of human infections. Although most Providencia infections involve the urinary tract, they are also associated with gastroenteritis, wound infections, and bacteremia. The aim of this study was evaluate the antimicrobial resistance rates of S. marcescens and Providencia spp. strains which had been isolated from various clinical materials obtained from different patients who belongs to intensive care units (ICU) and inpatient clinics. Methods: A total of 35 S. marcescens and Providencia spp. strains isolated from various clinical samples admitted to Medical Microbiology Laboratory, ANS Research and Practice Hospital, Afyon Kocatepe University between October 2013 and September 2015 were included in the study. Identification of the bacteria was determined by conventional methods and VITEK 2 system (bio-Merieux, Marcy l’etoile, France) was used additionally. Antibacterial resistance tests were performed by using Kirby Bauer disc (Oxoid, Hampshire, England) diffusion method following the recommendations of CLSI. Results: The distribution of clinical samples were as follows: upper and lower respiratory tract samples 26, 74.2 % wound specimen 6, 17.1 % blood cultures 3, 8.5%. Of the 35 S. marcescens and Providencia spp. strains; 28, 80% were isolated from clinical samples sent from ICU. The resistance rates of S. marcescens strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 8.5 %, 22.8 %, 11.4 %, 2.8 %, 17.1 %, 40 %, 28.5 % and 5.7 % respectively. Resistance rates of Providencia spp. strains against trimethoprim-sulfamethoxazole, piperacillin-tazobactam, imipenem, gentamicin, ciprofloxacin, ceftazidime, cefepime and amikacin were found to be 10.2 %, 33,3 %, 18.7 %, 8.7 %, 13.2 %, 38.6 %, 26.7%, and 11.8 % respectively. Conclusion: S. marcescens is usually resistant to ampicillin, amoxicillin, amoxicillin/clavulanate, ampicillin/sulbactam, cefuroxime, cephamycins, nitrofurantoin, and colistin. The most effective antibiotic on the total of S. marcescens strains was found to be gentamicin 2.8 %, of the totally tested strains the highest resistance rate found against to ceftazidime 40 %. The lowest and highest resistance rates were found against gentamiycin and ceftazidime with the rates of 8.7 % and 38.6 % for Providencia spp.

Keywords: Serratia marcescens, Providencia spp., antibiotic resistance, intensive care unit

Procedia PDF Downloads 219
333 Study of the Hydrodynamic of Electrochemical Ion Pumping for Lithium Recovery

Authors: Maria Sofia Palagonia, Doriano Brogioli, Fabio La Mantia

Abstract:

In the last decade, lithium has become an important raw material in various sectors, in particular for rechargeable batteries. Its production is expected to grow more and more in the future, especially for mobile energy storage and electromobility. Until now it is mostly produced by the evaporation of water from salt lakes, which led to a huge water consumption, a large amount of waste produced and a strong environmental impact. A new, clean and faster electrochemical technique to recover lithium has been recently proposed: electrochemical ion pumping. It consists in capturing lithium ions from a feed solution by intercalation in a lithium-selective material, followed by releasing them into a recovery solution; both steps are driven by the passage of a current. In this work, a new configuration of the electrochemical cell is presented, used to study and optimize the process of the intercalation of lithium ions through the hydrodynamic condition. Lithium Manganese Oxide (LiMn₂O₄) was used as a cathode to intercalate lithium ions selectively during the reduction, while Nickel Hexacyano Ferrate (NiHCF), used as an anode, releases positive ion. The effect of hydrodynamics on the process has been studied by conducting the experiments at various fluxes of the electrolyte through the electrodes, in terms of charge circulated through the cell, captured lithium per unit mass of material and overvoltage. The result shows that flowing the electrolyte inside the cell improves the lithium capture, in particular at low lithium concentration. Indeed, in Atacama feed solution, at 40 mM of lithium, the amount of lithium captured does not increase considerably with the flux of the electrolyte. Instead, when the concentration of the lithium ions is 5 mM, the amount of captured lithium in a single capture cycle increases by increasing the flux, thus leading to the conclusion that the slowest step in the process is the transport of the lithium ion in the liquid phase. Furthermore, an influence of the concentration of other cations in solution on the process performance was observed. In particular, the capturing of the lithium using a different concentration of NaCl together with 5 mM of LiCl was performed, and the results show that the presence of NaCl limits the amount of the captured lithium. Further studies can be performed in order to understand why the full capacity of the material is not reached at the highest flow rate. This is probably due to the porous structure of the material since the liquid phase is likely not affected by the convection flow inside the pores. This work proves that electrochemical ion pumping, with a suitable hydrodynamic design, enables the recovery of lithium from feed solutions at the lower concentration than the sources that are currently exploited, down to 1 mM.

Keywords: desalination battery, electrochemical ion pumping, hydrodynamic, lithium

Procedia PDF Downloads 187
332 The Covid Pandemic at a Level III Trauma Center: Challenges in the Management of the Spine Trauma.

Authors: Joana PaScoa Pinheiro, David Goncalves Ferreira, Filipe Ramos, Joaquim Soares Do Brito, Samuel Martins, Marco Sarmento

Abstract:

Introduction: The SARS-CoV-2 (COVID-19) pandemic was identified in January 2020 in China, in the city of Wuhan. The increase in the number of cases over the following months was responsible for the restructuring of hospitals and departments in order to accommodate admissions related to COVID-19. Essential services, such as trauma, had to readapt to maintain their functionality and thus guarantee quick and safe access in case of an emergency. Objectives: This study describes the impact of COVID-19 on a Level III Trauma Center and particularly on the clinical management of hospitalized patients with spine injuries. Study Design & Methods: This is a retrospective cohort study whose results were obtained through the medical records of patients with spine injuries who underwent surgical intervention in the years 2019 and 2020 (period from March 1st to December 31st). A comparison between the two groups was made. In the study patients with injuries in the context of trauma were included who underwent surgery in the periods previously described. Patients hospitalized with a spine injury in a non-traumatic context and/or were not surgically treated were excluded. Results: In total, 137 patients underwent trauma spine surgery of which 71 in 2019 (51.8%) were without significant differences in intergroup comparisons. The most frequent injury mechanism in 2019 was motor vehicle crash (47.9%) compared to 2020 which was of a person falling from a height between 2-4 meters (37.9%). Cervical trauma was reported to be the most frequent spine injury in both years. There was a significant decrease in the need for intensive care in 2020, 51.4% vs 30.3%, p = .015 and the number of complications was also lower in 2020 (1.35% vs 0.98%), including the number of deaths, being the difference marginally significant. There were no significant differences regarding time for presentation to surgery or in the total days of hospitalization. Conclusions: The restructuring made in the trauma unit at a Level III Trauma Center in the context of the current COVID-19 pandemic was effective, with no significant differences between the years of 2019 vs 2020 when compared with the time for presentation to surgery or the number of days of hospitalization. It was also found that lockdown rules in 2020 were probably responsible for the decrease in the number of road traffic accidents, which justifies a significant decrease in the need for intensive care as well as in the number of complications in patients hospitalized in the context of spine trauma.

Keywords: trauma, spine, impact, covid-19

Procedia PDF Downloads 222
331 Analysis of Eco-Efficiency and the Determinants of Family Agriculture in Southeast Spain

Authors: Emilio Galdeano-Gómez, Ángeles Godoy-Durán, Juan C. Pérez-Mesa, Laura Piedra-Muñoz

Abstract:

Eco-efficiency is receiving ever-increasing interest as an indicator of sustainability, as it links environmental and economic performances in productive activities. In agriculture, these indicators and their determinants prove relevant due to the close relationships in this activity between the use of natural resources, which is generally limited, and the provision of basic goods to society. In this context, various analyses have focused on eco-efficiency by considering individual family farms as the basic production unit. However, not only must the measure of efficiency be taken into account, but also the existence of a series of factors which constitute socio-economic, political-institutional, and environmental determinants. Said factors have been studied to a lesser extent in the literature. The present work analyzes eco-efficiency at a micro level, focusing on small-scale family farms as the main decision-making units in horticulture in southeast Spain, a sector which represents about 30% of the fresh vegetables produced in the country and about 20% of those consumed in Europe. The objectives of this study are a) to obtain a series of eco-efficiency indicators by estimating several pressure ratios and economic value added in farming, b) to analyze the influence of specific social, economic and environmental variables on the aforementioned eco-efficiency indicators. The present work applies the method of Data Envelopment Analysis (DEA), which calculates different combinations of environmental pressures (water usage, phytosanitary contamination, waste management, etc.) and aggregate economic value. In a second stage, an analysis is conducted on the influence of the socio-economic and environmental characteristics of family farms on the eco-efficiency indicators, as endogeneous variables, through the use of truncated regression and bootstrapping techniques, following Simar-Wilson methodology. The results reveal considerable inefficiency in aspects such as waste management, while there is relatively little inefficiency in water usage and nitrogen balance. On the other hand, characteristics, such as product specialization, the adoption of quality certifications and belonging to a cooperative do have a positive impact on eco-efficiency. These results are deemed to be of interest to agri-food systems structured on small-scale producers, and they may prove useful to policy-makers as regards managing public environmental programs in agriculture.

Keywords: data envelopment analysis, eco-efficiency, family farms, horticulture, socioeconomic features

Procedia PDF Downloads 154
330 Evaluating Social Sustainability in Historical City Center in Turkey: Case Study of Bursa

Authors: Şeyda Akçalı

Abstract:

This study explores the concept of social sustainability and its characteristics in terms of neighborhood (mahalle) which is a social phenomenon in Turkish urban life. As social sustainability indicators that moving away traditional themes toward multi-dimensional measures, the solutions for urban strategies may be achieved through learning lessons from historical precedents. It considers the inherent values of traditional urban forms contribute to the evolution of the city as well as the social functions of it. The study aims to measure non-tangible issues in order to evaluate social sustainability in historic urban environments and how they could contribute to the current urban planning strategies. The concept of neighborhood (mahalle) refers to a way of living that represents the organization of Turkish social and communal life rather than defining an administrative unit for the city. The distinctive physical and social features of neighborhood illustrate the link between social sustainability and historic urban environment. Instead of having a nostalgic view of past, it identifies both the failures and successes and extract lessons of traditional urban environments and adopt them to modern context. First, the study determines the aspects of social sustainability which are issued as the key themes in the literature. Then, it develops a model by describing the social features of mahalle which show consistency within the social sustainability agenda. The model is used to analyze the performance of traditional housing area in the historical city center of Bursa, Turkey whether it meets the residents’ social needs and contribute collective functioning of the community. Through a questionnaire survey exercised in the historic neighborhoods, the residents are evaluated according to social sustainability criteria of neighborhood. The results derived from the factor analysis indicate that social aspects of neighborhood are social infrastructure, identity, attachment, neighborliness, safety and wellbeing. Qualitative evaluation shows the relationship between key aspects of social sustainability and demographic and socio-economic factors. The outcomes support that inherent values of neighborhood retain its importance for the sustainability of community although there must be some local arrangements for few factors with great attention not to compromise the others. The concept of neighborhood should be considered as a potential tool to support social sustainability in national political agenda and urban policies. The performance of underlying factors in historic urban environment proposes a basis for both examining and improving traditional urban areas and how it may contribute to the overall city.

Keywords: historical city center, mahalle, neighborhood, social sustainability, traditional urban environment, Turkey

Procedia PDF Downloads 262
329 Stilbenes as Sustainable Antimicrobial Compounds to Control Vitis Vinifera Diseases

Authors: David Taillis, Oussama Becissa, Julien Gabaston, Jean-Michel Merillon, Tristan Richard, Stephanie Cluzet

Abstract:

Nowadays, there is a strong pressure to reduce the phytosanitary inputs of synthetic chemistry in vineyards. It is, therefore, necessary to find viable alternatives in order to protect the vine against its major diseases. For this purpose, we suggest the use of a plant extract enriched in antimicrobial compounds. Being produced from vine trunks and roots, which are co-products of wine production, the extract produced is part of a circular economy. The antimicrobial molecules present in this plant material are polyphenols and, more particularly, stilbenes, which are derived from a common base, the resveratrol unit, and that are well known vine phytoalexins. The stilbenoids were extracted from trunks and roots (30/70, w/w) by a double extraction with ethyl acetate followed by enrichment by liquid-liquid extraction. The produced extract was characterized by UHPLC-MS, then its antimicrobial activities were tested on Plasmopara viticola and Botrytis cinerea in the laboratory and/or in greenhouse and in vineyard. The major compounds were purified, and their antimicrobial activity was evaluated on B. cinerea. Moreover, after its spraying, the effect of the stilbene extract on the plant defence status was evaluated by analysis of defence gene expression. UHPLC-MS analysis revealed that the extract contains 50% stilbenes with resveratrol, ε-viniferin and r-viniferin as major compounds. The extract showed antimicrobial activities on P. viticola with IC₅₀ and IC₁₀₀ respectively of 90 and 300 mg/L in the laboratory. In addition, it inhibited 40% of downy mildew development in greenhouse. However, probably because of the sensitivity of stilbenes to the environment, such as UV degradation, no activity has been observed in vineyard towards P. viticola development. For B. cinerea, the extract IC50 was 123 mg/L, with resveratrol and ε-viniferin being the most active stilbenes (IC₅₀ of 88 and 142 mg/L, respectively). The analysis of the expression of defence genes revealed that the extract can induce the expression of some defence genes 24, 48, and 72 hours after treatment, meaning that the extract has a defence-stimulating effect at least for the first three days after treatment. In conclusion, we produced a plant extract enriched in stilbenes with antimicrobial properties against two major grapevine pathogenic agents P. viticola and B. cinerea. In addition, we showed that this extract displayed eliciting activity of plant defences. This extract can therefore represent, after formulation development, a viable eco-friendly alternative for vineyard protection. Subsequently, the effect of the stilbenoid extract on primary metabolism will be evaluated by quantitative NMR.

Keywords: antimicrobial, bioprotection, grapevine, Plasmopara viticola, stilbene

Procedia PDF Downloads 187
328 A Case Study on Experiences of Clinical Preceptors in the Undergraduate Nursing Program

Authors: Jacqueline M. Dias, Amina A Khowaja

Abstract:

Clinical education is one of the most important components of a nursing curriculum as it develops the students’ cognitive, psychomotor and affective skills. Clinical teaching ensures the integration of knowledge into practice. As the numbers of students increase in the field of nursing coupled with the faculty shortage, clinical preceptors are the best choice to ensure student learning in the clinical settings. The clinical preceptor role has been introduced in the undergraduate nursing programme. In Pakistan, this role emerged due to a faculty shortage. Initially, two clinical preceptors were hired. This study will explore clinical preceptors views and experiences of precepting Bachelor of Science in Nursing (BScN) students in an undergraduate program. A case study design was used. As case studies explore a single unit of study such as a person or very small number of subjects; the two clinical preceptors were fundamental to the study and served as a single case. Qualitative data were obtained through an iterative process using in depth interviews and written accounts from reflective journals that were kept by the clinical preceptors. The findings revealed that the clinical preceptors were dedicated to their roles and responsibilities. Another, key finding was that clinical preceptors’ prior knowledge and clinical experience were valuable assets to perform their role effectively. The clinical preceptors found their new role innovative and challenging; it was stressful at the same time. Findings also revealed that in the clinical agencies there were unclear expectations and role ambiguity. Furthermore, clinical preceptors had difficulty integrating theory into practice in the clinical area and they had difficulty in giving feedback to the students. Although this study is localized to one university, generalizations can be drawn from the results. The key findings indicate that the role of a clinical preceptor is demanding and stressful. Clinical preceptors need preparation prior to precepting students on clinicals. Also, institutional support is fundamental for their acceptance. This paper focuses on the views and experiences of clinical preceptors undertaking a newly established role and resonates with the literature. The following recommendations are drawn to strengthen the role of the clinical preceptors: A structured program for clinical preceptors is needed along with mentorship. Clinical preceptors should be provided with formal training in teaching and learning with emphasis on clinical teaching and giving feedback to students. Additionally, for improving integration of theory into practice, clinical modules should be provided ahead of the clinical. In spite of all the challenges, ten more clinical preceptors have been hired as the faculty shortage continues to persist.

Keywords: baccalaureate nursing education, clinical education, clinical preceptors, nursing curriculum

Procedia PDF Downloads 138
327 Audit Outcome Cardiac Arrest Cases (2019-2020) in Emergency Department RIPAS Hospital, Brunei Darussalam

Authors: Victor Au, Khin Maung Than, Zaw Win Aung, Linawati Jumat

Abstract:

Background & Objectives: Cardiac arrests can occur anywhere or anytime, and most of the cases will be brought to the emergency department except the cases that happened in at in-patient setting. Raja IsteriPangiran Anak Saleha (RIPAS) Hospital is the only tertiary government hospital which located in Brunei Muara district and received all referral from other Brunei districts. Data of cardiac arrests in Brunei Darussalam scattered between Emergency Medical Ambulance Services (EMAS), Emergency Department (ED), general inpatient wards, and Intensive Care Unit (ICU). In this audit, we only focused on cardiac arrest cases which had happened or presented to the emergency department RIPAS Hospital. Theobjectives of this audit were to look at demographic of cardiac arrest cases and the survival to discharge rate of In-Hospital Cardiac Arrest (IHCA) and Out-Hospital Cardiac Arrest (OHCA). Methodology: This audit retrospective study was conducted on all cardiac arrest cases that underwent Cardiopulmonary Resuscitation (CPR) in ED RIPAS Hospital, Brunei Muara, in the year 2019-2020. All cardiac arrest cases that happened or were brought in to emergency department were included. All the relevant data were retrieved from ED visit registry book and electronic medical record “Bru-HIMS” with keyword diagnosis of “cardiac arrest”. Data were analyzed and tabulated using Excel software. Result: 313 cardiac arrests were recorded in the emergency department in year 2019-2020. 92% cases were categorized as OHCA, and the remaining 8% as IHCA. Majority of the cases were male with age between 50-60 years old. In OHCA subgroup, only 12.4% received bystander CPR, and 0.4% received Automatic External Defibrillator (AED) before emergency medical personnel arrived. Initial shockable rhythm in IHCA group accounted for 12% compare to 4.9% in OHCA group. Outcome of ED resuscitation, 32% of IHCA group achieved return of spontaneous circulation (ROSC) with a survival to discharge rate was 16%. For OHCA group, 12.35% achieved ROSC, but unfortunately, none of them survive till discharge. Conclusion: Standardized registry for cardiac arrest in the emergency department is required to provide valid baseline data to measure the quality and outcome of cardiac arrest. Zero survival rate for out hospital cardiac arrest is very concerning, and it might represent the significant breach in cardiac arrest chains of survival. Systematic prospective data collection is needed to identify contributing factors and to improve resuscitation outcome.

Keywords: cardiac arrest, OHCA, IHCA, resuscitation, emergency department

Procedia PDF Downloads 59
326 Structural Investigation of the GAF Domain Protein BPSL2418 from Burkholderia pseudomallei

Authors: Mona G. Alharbi

Abstract:

A new family of methionine-sulfoxide reductase (Msr) was recently discovered and was named free methionine sulfoxide reductase (fRMsr). This family includes enzymes with a reductase activity toward the free R isomer of a methionine sulfoxide substrate. The fRMsrs have a GAF domain topology, a domain, which was previously identified as having in some cases a cyclic nucleotide phosphodiesterase activity. The classification of fRMsrs as GAF domains revealed a new function can be added to the GAF domain family. Interestingly the four members identified in the fRMsr family share the GAF domain structure and the presence of three conserved cysteines in the active site with free R methionine sulfoxide substrate specificity. This thesis presents the crystal structures of reduced, free Met-SO substrate-bound and MES-bound forms of a new fRMsr from Burkholderia pseudomallei (BPSL2418). BPSL2418 was cloned, overexpressed and purified to enable protein crystallization. The crystallization trials for reduced, Met-SO-bound and MES-bound forms of BPSL2418 were prepared and reasonable crystals of each form were produced. The crystal structures of BPSL2418MES, BPSL2418Met-SO and BPSL2418Reduced were solved at 1.18, 1.4 and 2.0Å, respectively by molecular replacement. The BPSL2418MES crystal belongs to space group P 21 21 21 while BPSL2418Met-SO and BPSL2418Reduced crystals belong to space group P 1 21 1. All three forms share the GAF domain structure of six antiparallel β-strands and four α-helices with connecting loops. The antiparallel β-strands (β1, β2, β5 and β6) are located in the center of the BPSL2418 structure flanked on one side by a three α-helices (α1, α2 and α4) and on the other side by a (loop1, β3, loop2, α3, β4 loop4) unit where loop4 forms a capping flap and covers the active site. The structural comparison of the three forms of BPSL2418 indicates that the catalytically important cysteine is CYS109, where the resolving cysteine is CYS75, which forms a disulfide bond with CYS109. They also suggest that the third conserved cysteine in the active site, CYS85, which is located in α3, is a non-essential cysteine for the catalytic function but it may play a role in the binding of the substrate. The structural comparison of the three forms reveals that conformational changes appear in the active site particularly involving loop4 and CYS109 during catalysis. The 3D structure of BPSL2418 shows strong structure similarity to fRMsrs enzymes, which further suggests that BPSL2418 acts as a free Met-R-SO reductase and shares the catalytic mechanism of fRMsr family.

Keywords: Burkholderia pseudomallei, GAF domain protein, methionine sulfoxide reductase, protein crystallization

Procedia PDF Downloads 363
325 Safety Evaluation of Intramuscular Administration of Zuprevo® Compared to Draxxin® in the Treatment of Swine Respiratory Disease at Weaning Age

Authors: Josine Beek, S. Agten, R. Del Pozo, B. Balis

Abstract:

The objective of the present study was to compare the safety of intramuscular administration of Zuprevo® (tildipirosin, 40 mg/mL) with Draxxin® (tulathromycin, 100 mg/mL) in the treatment of swine respiratory disease at weaning age. The trial was carried out in two farrow-to-finish farms with 300 sows (farm A) and 500 sows (farm B) in a batch-production system. Farm A had no history of respiratory problems, whereas farm B had a history of respiratory outbreaks with increased mortality ( > 2%) in the nursery. Both farms were positive to Pasteurella multocida, Bordetella bronchiseptica, Actinobacillus pleuropneumoniae and Haemophilus parasuis. From each farm, one batch of piglets was included (farm A: 644 piglets; farm B: 963 piglets). One day before weaning (day 0; 18-21 days of age), piglets were identified by an individual ear tag and randomly assigned to a treatment group. At day 0, Group 1 was treated with a single intramuscular injection with Zuprevo® (tildipirosin, 40 mg/mL; 1 mL/10 kg) and group 2 with Draxxin® (tulathromycin, 100 mg/mL; 1 mL/40 kg). For practical reasons, dosage of the product was adjusted according to three weight categories: < 4 kg, 4-6 kg and > 6 kg. Within each farm, piglets of both groups were comingled at weaning and subsequently managed and located in the same facilities and with identical environmental conditions. Our study involved the period from day 0 until 10 weeks of age. Safety of treatment was evaluated by 1) visual examination for signs of discomfort directly after treatment and after 15 min, 1 h and 24 h and 2) mortality rate within 24 h after treatment. Efficacy of treatment was evaluated based on mortality rate from day 0 until 10 weeks of age. Each piglet that died during the study period was necropsied by the herd veterinarian to determine the probable cause of death. Data were analyzed using binary logistic regression and differences were considered significant if p < 0.05. The pig was the experimental unit. In total, 848 piglets were treated with tildipirosin and 759 piglets with tulathromycin. In farm A, one piglet with retarded growth ( < 1 kg at 18 days of age) showed an adverse reaction after injection of tildipirosin: lateral recumbence and dullness for ± 30 sec. The piglet recovered after 1-2 min. This adverse reaction was probably due to overdosing (12 mg/kg). No adverse effect of treatment was observed in any other piglet. There was no mortality within 24 h after treatment. No significant difference was found in mortality rate between both groups from day 0 until 10 weeks of age. In farm A, overall mortality rate was 0.3% (2/644). In farm B, mortality rate was 0.2% (1/502) in group 1 (tildipirosin) and 0.9% (4/461) in group 2 (tulathromycin)(p=0.60). The necropsy of piglets that died during the study period revealed no macroscopic lesions of the respiratory tract. In conclusion, Zuprevo® (tildipirosin, 40 mg/mL) was shown to be a safe and efficacious alternative to Draxxin® (tulathromycin, 100 mg/mL) for the early treatment of swine respiratory disease at weaning age.

Keywords: antibiotic treatment, safety, swine respiratory disease, tildipirosin

Procedia PDF Downloads 365
324 Factors Contributing to Adverse Maternal and Fetal Outcome in Patients with Eclampsia

Authors: T. Pradhan, P. Rijal, M. C. Regmi

Abstract:

Background: Eclampsia is a multisystem disorder that involves vital organs and failure of these may lead to deterioration of maternal condition and hypoxia and acidosis of fetus resulting in high maternal and perinatal mortality and morbidity. Thus, evaluation of the contributing factors for this condition and its complications leading to maternal deaths should be the priority. Formulating the plan and protocol to decrease these losses should be our goal. Aims and Objectives: To evaluate the risk factors associated with adverse maternal and fetal outcome in patients with eclampsia and to correlate the risk factors associated with maternal and fetal morbidity and mortality. Methods: All patients with eclampsia admitted in Department of Obstetrics and Gynecology, B. P. Koirala Institute of Health Sciences were enrolled after informed consent from February 2013 to February 2014. Questions as per per-forma were asked to patients, and attendants like Antenatal clinic visits, parity, number of episodes of seizures, duration from onset of seizure to magnesium sulfate and the patients were followed as per the hospital protocol, the mode of delivery, outcome of baby, post partum maternal condition like maternal Intensive Care Unit admission, neurological impairment and mortality were noted before discharge. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS 11). Mean and percentage were calculated for demographic variables. Pearson’s correlation test and chi-square test were applied to find the relation between the risk factors and the outcomes. P value less than 0.05 was considered significant. Results: There were 10,000 antenatal deliveries during the study period. Fifty-two patients with eclampsia were admitted. All of the patients were unbooked for our institute. Thirty-nine patients were antepartum eclampsia. Thirty-one patients required mechanical ventilator support. Twenty-four patients were delivered by emergency c-section and 21 babies were Low Birth Weight and there were 9 stillbirths. There was one maternal mortality and 45 patients were discharged with improvement but 3 patients had neurological impairment. Mortality was significantly related with number of seizure episodes and time interval between seizure onset and administration of magnesium sulphate. Conclusion: Early detection and management of hypertensive complicating pregnancy during antenatal clinic check up. Early hospitalization and management with magnesium sulphate for eclampsia can help to minimize the maternal and fetal adverse outcomes.

Keywords: eclampsia, maternal mortality, perinatal mortality, risk factors

Procedia PDF Downloads 145
323 Monte Carlo Risk Analysis of a Carbon Abatement Technology

Authors: Hameed Rukayat Opeyemi, Pericles Pilidis, Pagone Emanuele

Abstract:

Climate change represents one of the single most challenging problems facing the world today. According to the National Oceanic and Administrative Association, Atmospheric temperature rose almost 25% since 1958, Artic sea ice has shrunk 40% since 1959 and global sea levels have risen more than 5.5 cm since 1990. Power plants are the major culprits of GHG emission to the atmosphere. Several technologies have been proposed to reduce the amount of GHG emitted to the atmosphere from power plant, one of which is the less researched Advanced zero emission power plant. The advanced zero emission power plants make use of mixed conductive membrane (MCM) reactor also known as oxygen transfer membrane (OTM) for oxygen transfer. The MCM employs membrane separation process. The membrane separation process was first introduced in 1899 when Walter Hermann Nernst investigated electric current between metals and solutions. He found that when a dense ceramic is heated, current of oxygen molecules move through it. In the bid to curb the amount of GHG emitted to the atmosphere, the membrane separation process was applied to the field of power engineering in the low carbon cycle known as the Advanced zero emission power plant (AZEP cycle). The AZEP cycle was originally invented by Norsk Hydro, Norway and ABB Alstom power (now known as Demag Delaval Industrial turbo machinery AB), Sweden. The AZEP drew a lot of attention because its ability to capture ~100% CO2 and also boasts of about 30-50 % cost reduction compared to other carbon abatement technologies, the penalty in efficiency is also not as much as its counterparts and crowns it with almost zero NOx emissions due to very low nitrogen concentrations in the working fluid. The advanced zero emission power plants differ from a conventional gas turbine in the sense that its combustor is substituted with the mixed conductive membrane (MCM-reactor). The MCM-reactor is made up of the combustor, low temperature heat exchanger LTHX (referred to by some authors as air pre-heater the mixed conductive membrane responsible for oxygen transfer and the high temperature heat exchanger and in some layouts, the bleed gas heat exchanger. Air is taken in by the compressor and compressed to a temperature of about 723 Kelvin and pressure of 2 Mega-Pascals. The membrane area needed for oxygen transfer is reduced by increasing the temperature of 90% of the air using the LTHX; the temperature is also increased to facilitate oxygen transfer through the membrane. The air stream enters the LTHX through the transition duct leading to inlet of the LTHX. The temperature of the air stream is then increased to about 1150 K depending on the design point specification of the plant and the efficiency of the heat exchanging system. The amount of oxygen transported through the membrane is directly proportional to the temperature of air going through the membrane. The AZEP cycle was developed using the Fortran software and economic analysis was conducted using excel and Matlab followed by optimization case study. This paper discusses techno-economic analysis of four possible layouts of the AZEP cycle. The Simple bleed gas heat exchange layout (100 % CO2 capture), Bleed gas heat exchanger layout with flue gas turbine (100 % CO2 capture), Pre-expansion reheating layout (Sequential burning layout) – AZEP 85 % (85 % CO2 capture) and Pre-expansion reheating layout (Sequential burning layout) with flue gas turbine– AZEP 85 % (85 % CO2 capture). This paper discusses Montecarlo risk analysis of four possible layouts of the AZEP cycle.

Keywords: gas turbine, global warming, green house gases, power plants

Procedia PDF Downloads 448
322 Comparative Study on Fire Safety Evaluation Methods for External Cladding Systems: ISO 13785-2 and BS 8414

Authors: Kyungsuk Cho, H. Y. Kim, S. U. Chae, J. H. Choi

Abstract:

Technological development has led to the construction of super-tall buildings and insulators are increasingly used as exterior finishing materials to save energy. However, insulators are usually combustible and vulnerable to fire. Fires like that at Wooshin Golden Suite Building in Busan, Korea in 2010 and that at CCTV Building in Beijing, China are the major examples of fire spread accelerated by combustible insulators. The exterior finishing materials of a high-rise building are not made of insulators only, but they are integrated with the building’s external cladding system. There is a limit in evaluating the fire safety of a cladding system with a single small-unit material such as a cone calorimeter. Therefore, countries provide codes to evaluate the fire safety of exterior finishing materials using full-scale tests. This study compares and to examine the applicability of the methods to Korea. Standard analysis showed differences in the type and size of fire sources and duration and exterior finishing materials also differed in size. In order to confirm the differences, fire tests were conducted on identical external cladding systems to compare fire safety. Although the exterior finishing materials were identical, varying degrees of fire spread were observed, which could be considered as differences in the type and size of the fire sources and duration. Therefore, it is deduced that extended studies should be conducted before the evaluation methods and standards are employed in Korea. The two standards for evaluating fire safety provided different results. Peak heat release rate was 5.5MW in ISO method and 3.0±0.5MW in BS method. Peak heat release rate in ISO method continued for 15 minutes. Fire ignition, growth, full development and decay evolved for 30 minutes in BS method where wood cribs were used as fire sources. Therefore, follow-up studies should be conducted to determine which of the two standards provides fire sources that approximate the size of flames coming out from the openings or those spreading to the outside when a fire occurs at a high-rise building.

Keywords: external cladding systems, fire safety evaluation, ISO 13785-2, BS 8414

Procedia PDF Downloads 220
321 The Concept of the Family and Its Principles from the Perspective of International Human Rights Instruments

Authors: Mahya Saffarinia

Abstract:

The family has existed as a natural unit of human relations from the beginning of creation and life of human society until now and has been the core of the relationship between women, men, and children. However, in the field of human relations, the definition of family, related rights and duties, principles governing the family, the impact of the family on other individual or social phenomena and various other areas have changed over time, especially in recent decades, and the subject has now become one of the important categories of studies including interdisciplinary studies. It is difficult to provide an accurate and comprehensive definition of the family, and in the context of different cultures, customs, and legal systems, different definitions of family are presented. The meaning of legal principles governing the family is the general rules of law that determine the organization of different dimensions of the family, and dozens of partial rules are inferred from it or defined in the light of these general rules. How each of these principles was formed has left its own detailed history. In international human rights standards, which have been gradually developed over the past 72 years, numerous data can be found that in some way represent a rule in the field of family law or provide an interpretation of existing international rules which also address obligations of governments in the field of family. Based on a descriptive-analytical method and by examining human rights instruments, the present study seeks to explain the effective elements in defining and the principles governing the family. This article makes it clear that international instruments do not provide a clear definition of the family and that governments are empowered to define the family in terms of the cultural context of their community. But at the same time, it has been stipulated that governments do not have the exclusive authority to provide this definition, and certain principles should be considered as essential elements. Also, 7 principles have been identified as general legal rules governing all international human rights instruments related to the family, such as the principle of voluntary family formation and the prohibition of forced marriage, and the principle of respecting human dignity for all family members. Each of these 7 principles has led to different debates, and the acceptance or non-acceptance of each of them has different consequences in the rights and duties related to the family and the relations between its members and even the family's interactions with others and society. One of the consequences of the validity of these principles in family-related human rights standards is that many of the existing legal systems of countries in some cases need to be amended and their regulations revised, and some established cultural traditions in societies that are considered inhumane in terms of these principles need to be modified and changed. Of course, this process of governing the principles derived from human rights standards over the family also has vulnerabilities and misinterpretations that should not be neglected.

Keywords: family, human rights, international instruments, principles

Procedia PDF Downloads 145
320 Purification of Bacillus Lipopeptides for Diverse Applications

Authors: Vivek Rangarajan, Kim G. Clarke

Abstract:

Bacillus lipopeptides are biosurfactants with wide ranging applications in the medical, food, agricultural, environmental and cosmetic industries. They are produced as a mix of three families, surfactin, iturin and fengycin, each comprising a large number of homologues of varying functionalities. Consequently, the method and degree of purification of the lipopeptide cocktail becomes particularly important if the functionality of the lipopeptide end-product is to be maximized for the specific application. However, downstream processing of Bacillus lipopeptides is particularly challenging due to the subtle variations observed in the different lipopeptide homologues and isoforms. To date, the most frequently used lipopeptide purification operations have been acid precipitation, solvent extraction, membrane ultrafiltration, adsorption and size exclusion. RP-HPLC (reverse phase high pressure liquid chromatography) also has potential for fractionation of the lipopeptide homologues. In the studies presented here, membrane ultrafiltration and RP-HPLC were evaluated for lipopeptide purification to different degrees of purities for maximum functionality. Batch membrane ultrafiltration using 50 kDa polyether sulphone (PES) membranes resulted in lipopeptide recovery of about 68% for surfactin and 82 % for fengycin. The recovery was further improved to 95% by using size-conditioned lipopeptide micelles. The conditioning of lipopeptides with Ca2+ ions resulted in uniformly sized micelles with average size of 96.4 nm and a polydispersity index of 0.18. The size conditioning also facilitated removal of impurities (molecular weight ranging between 2335-3500 Da) through operation of the system under dia-filtration mode, in a way similar to salt removal from protein by dialysis. The resultant purified lipopeptide was devoid of macromolecular impurities and could ideally suit applications in the cosmetic and food industries. Enhanced purification using RP-HPLC was carried out in an analytical C18 column, with the aim to fractionate lipopeptides into their constituent homologues. The column was eluted with mobile phase comprising acetonitrile and water over an acetonitrile gradient, 35% - 80%, over 70 minutes. The gradient elution program resulted in as many as 41 fractions of individual lipopeptide homologues. The efficacy test of these fractions against fungal phytopathogens showed that first 21 fractions, identified to be homologues of iturins and fengycins, displayed maximum antifungal activities, suitable for biocontrol in the agricultural industry. Thus, in the current study, the downstream processing of lipopeptides leading to tailor-made products for selective applications was demonstrated using two major downstream unit operations.

Keywords: bacillus lipopeptides, membrane ultrafiltration, purification, RP-HPLC

Procedia PDF Downloads 186