Search results for: clinical quality and safety

Authors: Siamak Eskandari, Neda Ebadi

Abstract:

Among common electronic parts which have been invented and have made a great revolution in the lighting system through the world, certainly LEDs have no rival. These small parts with their very low power consumption, very dazzling and powerful light and small size and with their extremely high lifetime- compared to incandescent bulbs and compact fluorescent lamp (CFLs) have undoubtedly revolutionized the lighting industry of the world. Based on conducted studies and experiments, in addition to their acceptable light and low power consumption -compared to incandescent bulbs and CFLs-, they have very low and in some cases zero environmental pollution and negative effects on human beings. Because of their longevity, in the case of using high-quality circuits and proper and consistent use of LEDs in conventional and intelligent buildings, there will be no need to replace the burnout lamps, for a long time (10 years). In this study which was conducted on 10-watt power LEDs with suitable heatsink/cooling, considerable amount of heat was generated during lighting after 5 minutes and 45 seconds. The temperature rose to above 99 degrees Celsius and this amount of heat can raise the water temperature to 60 degrees Celsius and more. Based on conducted experiments, this can provide the heat required for bathing, washing, radiators (in cold seasons) easily and only by imposing very low cost and it will be a big step in the optimization of energy consumption in the future.

Keywords: energy, light, water, optimization of power LED

Procedia PDF Downloads 117

Authors: C. Hall, J. Ramos, V. Ramasamy

Abstract:

Hydrocarbon-based fuel vehicles are a major contributor to air pollution due to harmful emissions produced, leading to a demand for cleaner fuel types. A leader in this pursuit is hydrogen, with its application in vehicles producing zero harmful emissions and the only by-product being water. To compete with the performance of conventional vehicles, hydrogen gas must be stored on-board of vehicles in cylinders at high pressures (35–70 MPa) and have a short refueling duration (approximately 3 mins). However, the fast-filling of hydrogen cylinders causes a significant rise in temperature due to the combination of the negative Joule-Thompson effect and the compression of the gas. This can lead to structural failure and therefore, a maximum allowable internal temperature of 85°C has been imposed by the International Standards Organization. The technological solution to tackle the issue of rapid temperature rise during the refueling process is to decrease the temperature of the gas entering the cylinder. Pre-cooling of the gas uses a heat exchanger and requires energy for its operation. Thus, it is imperative to determine the least amount of energy input that is required to lower the gas temperature for cost savings. A validated universal thermodynamic model is used to identify an energy-efficient pre-cooling strategy. The model requires negligible computational time and is applied to previously validated experimental cases to optimize pre-cooling requirements. The pre-cooling characteristics include the location within the refueling timeline and its duration. A constant pressure-ramp rate is imposed to eliminate the effects of rapid changes in mass flow rate. A pre-cooled gas temperature of -40°C is applied, which is the lowest allowable temperature. The heat exchanger is assumed to be ideal with no energy losses. The refueling of the cylinders is modeled with the pre-cooling split in ten percent time intervals. Furthermore, varying burst durations are applied in both the early and late stages of the refueling procedure. The model shows that pre-cooling in the later stages of the refuelling process is more energy-efficient than early pre-cooling. In addition, the efficiency of pre-cooling towards the end of the refueling process is independent of the pressure profile at the inlet. This leads to the hypothesis that pre-cooled gas should be applied as late as possible in the refueling timeline and at very low temperatures. The model had shown a 31% reduction in energy demand whilst achieving the same final gas temperature for a refueling scenario when pre-cooling was applied towards the end of the process. The identification of the most energy-efficient refueling approaches whilst adhering to the safety guidelines is imperative to reducing the operating cost of hydrogen refueling stations. Heat exchangers are energy-intensive and thus, reducing the energy requirement would lead to cost reduction. This investigation shows that pre-cooling should be applied as late as possible and for short durations.

Keywords: cylinder, hydrogen, pre-cooling, refueling, thermodynamic model

Procedia PDF Downloads 67

Authors: Sinem Bulkan

Abstract:

This study introduces the construct of psychopathic manager behaviour and aims for the development of psychopathic manager behaviour (Psycho-Man B) measure. The study also aims for the understanding of the relationship between psychopathic manager behaviour and workplace deviance while investigating the mediating role of a revenge motive and the moderating roles of the core self-evaluations and the attitude importance. Data were collected from 519 employees from a wide variety of jobs and industries who currently work for or previously worked for a manager in a collectivist culture, Turkey. Psycho-Man B Measure was developed resulting in five dimensions as opposed to the proposed ten dimensions. Simple linear and hierarchical regression analyses were conducted to test the hypotheses. The results of simple linear regression analyses showed that psychopathic manager behaviour was positively significantly related to supervisor-directed and organisation-directed deviance. Revenge motive towards the manager partially mediated the relationship between psychopathic manager behaviour and supervisor-directed deviance. Similarly, revenge motive towards the organisation partially mediated the relationship between psychopathic manager behaviour and organisation-directed deviance. Furthermore, no support was found for the expected moderating role of core self-evaluations in the revenge motive towards the manager-supervisor-directed deviance and revenge motive towards the organisation-organisation-directed deviance relationships. Attitude importance moderated the relationship between revenge motive towards the manager and supervisor-directed deviance; revenge motive towards the organisation and organisation-directed deviance. Moderated-mediation hypotheses were not supported for core self-evaluations but were supported for the attitude importance. Additional analyses for sub-dimensions were conducted to further examine the hypotheses. Demographic variables were examined through independent samples t-tests, and one way ANOVA. Finally, findings are discussed; limitations, suggestions and implications are presented. The major contribution of this study is that ‘psychopathic manager behaviour’ construct was introduced to the literature and a scale for the reliable identification of psychopathic manager behaviour was developed in to evaluate managers’ level of sub-clinical psychopathy in the workforce. The study introduced that employees engage in different forms of supervisor-directed deviance and organisation-directed deviance depending on the level of the emotions and personal goals. Supervisor-directed deviant behaviours and organisation-directed deviant behaviours became distinct in a way as impulsive and premeditated, active or passive, direct and indirect actions. Accordingly, it is important for organisations to notice that employees’ level of affective state and attitude importance for psychopathic manager behaviours predetermine the certain type of employee deviant behaviours.

Keywords: attitude importance, core self evaluations, psychopathic manager behaviour, revenge motive, workplace deviance

Procedia PDF Downloads 236

Authors: Tabitha Mberi, Tirus Wanyoike, Joseph Sevilla

Abstract:

The use of Information and Communication Technology (ICT) in Government is gradually becoming a major requirement to transform delivery of services to its stakeholders by improving quality of service and efficiency. In Kenya, the devolvement of government from local authorities to county governments has resulted in many counties adopting online revenue collection systems which can be easily accessed by its stakeholders. Strathmore Research and Consortium Centre (SRCC) implemented a revenue collection system in Taita Taveta, a County in coastal Kenya. It consisted of two systems that are integrated; an online system dubbed “CountyPro” for processing county services such as Business Permit applications, General Billing, Property Rates Payments and any other revenue streams from the county. The second part was a Point of Sale(PoS) system used by the county revenue collectors to charge for market fees and vehicle parking fees. This study assesses the success and challenges in adoption of the integrated system. Qualitative and quantitative data collection methods were used to collect data on the adoption of the system with the researcher using focus groups, interviews, and questionnaires to collect data from various users of the system An analysis was carried out and revealed that 87% of the county revenue officers who are situated in county offices describe the system as efficient and has made their work easier in terms of processing of transactions for customers.

Keywords: e-government, counties, information technology, online system, point of sale

Procedia PDF Downloads 219

Authors: Abdul Razak Bin Ahmad, Mohd Mahzan Awang

Abstract:

Appreciation of patriotism value is important for every student to be able to become a quality citizen and good for the country. Realizing this situation, Malaysia has introduced history education for primary school students since 2014. One of the aims is to provide basic knowledge on patriotism as well as to promote patriotic behaviour among school pupils. In order to examine the relationship between the students’ knowledge and their behaviour, a survey study was carried out. A set of questionnaire was designed and developed based prior studies on history education and patriotism. The sample of this survey was 153 primary school students aged 12 years old (Standard Six). Data collected and analysed using SPSS (Statistical Package for The Social Science 20.0). The results showed that the level of knowledge and patriotism practise at the moderate levels. Inferential statistic results revealed that there is no significant difference between genders with regards to patriotism knowledge and patriotism practice through history education subject. Results also demonstrated that there is a significant relationship between knowledge and the practice of patriotism values among the students. This means that knowledge on patriotism is important for promoting patriotic behaviour and practice in primary schools. This study implies that teaching students to understand and comprehend the concept of patriotism is vital to promote patriotic behaviour among students. Therefore, teachers should master pedagogical skills and good content knowledge on patriotism as mechanisms to promote effective learning in history education subjects. creativity in teaching history education subjects is also needed.

Keywords: history education, knowledge, primary school, patriotism values, teachers

Procedia PDF Downloads 350

Authors: Anisuzzaman Khan, A. J. K. Masud

Abstract:

Bangladesh is the largest delta in the world predominantly comprising large network of rives and wetlands. Wetlands in Bangladesh are represented by inland freshwater, estuarine brakishwater and tidal salt-water coastal wetlands. Bangladesh possesses enormous area of wetlands including rivers and streams, freshwater lakes and marshes, haors, baors, beels, water storage reservoirs, fish ponds, flooded cultivated fields and estuarine systems with extensive mangrove swamps. The past, present, and future of Bangladesh, and its people’s livelihoods are intimately connected to its relationship with water and wetlands. More than 90% of the country’s total area consists of alluvial plains, crisscrossed by a complex network of rivers and their tributaries. Floodplains, beels (low-lying depressions in the floodplain), haors (deep depression) and baors (oxbow lakes) represent the inland freshwater wetlands. Over a third of Bangladesh could be termed as wetlands, considering rivers, estuaries, mangroves, floodplains, beels, baors and haors. The country’s wetland ecosystems also offer critical habitats for globally significant biological diversity. Of these the deeply flooded basins of north-east Bangladesh, known as haors, are a habitat of wide range of wild flora and fauna unique to Bangladesh. The haor basin lies within the districts of Sylhet, Sunamgonj, Netrokona, Kishoregonj, Habigonj, Moulvibazar, and Brahmanbaria in the Northeast region of Bangladesh comprises the floodplains of the Meghna tributaries and is characterized by the presence of numerous large, deeply flooded depressions, known as haors. It covers about around 8,568 km2 area of Bangladesh. The topography of the region is steep at around foothills in the north and slopes becoming mild and milder gradually at downstream towards south. Haor is a great reservoir of aquatic biological resources and acts as the ecological safety net to the nature as well as to the dwellers of the haor. But in reality, these areas are considered as wastelands and to make these wastelands into a productive one, a one sided plan has been implementing since long. The programme is popularly known as Flood Control, Drainage and Irrigation (FCDI) which is mainly devoted to increase the monoculture rice production. However, haor ecosystem is a multiple-resource base which demands an integrated sustainable development approach. The ongoing management approach is biased to only rice production through FCDI. Thus this primitive mode of action is diminishing other resources having more economic potential ever thought.

Keywords: freshwater wetlands, biological diversity, biological resources, conservation and sustainable development

Procedia PDF Downloads 298

Authors: Lilik Sudiajeng, Wiraga Wayan, Lanang Parwita I Gusti

Abstract:

This is the ongoing research started in 2013 with the final aim is to design the recharge wells both for housing and industry for ground water conservation in Bali - Indonesia. The research started in Denpasar Regency, one of the strategic areas in Bali. The research showed that there is some critical area of ground water resources, especially in north and west part of Denpasar Regency. It driven by the rapid increase of the tourism industry which is followed by the high rate of population, change of land use that leads to the decreasing of rain water catchment areas, and less awareness on preserve natural resources, including ground water. Focus Group Discussion concluded that in order to solve the problem of groundwater crisis, requires the contribution of all parties, started from making simple recharge well for housing. Because of the availability of land is limited and expensive, it is necessary to present an ergonomic shallow recharge well in accordance with the ability of the family or community. The ergonomics shallow recharge well is designed based on the data of hydrology and the characteristics of soil. The design is very flexible depending on the availability of land, environmentally friendly, energy efficient, culture-based, and affordable. To meet the recommended standard of ground water quality, then it equipped with a filtration and sedimentation ponds. Before design recharge wells is disseminated to the public, it is necessary to analyze the effectiveness of the wells to harvest and absorb rainwater into the ground.

Keywords: ergonomics, ground water resources, recharge well, sustainable

Procedia PDF Downloads 228

Authors: Zohre Shahhosseini, Mehdi Pourasghar, AliReza Khalilian, Fariba Salehi

Abstract:

Objective: The prevalence of anxiety during pregnancy, particularly in developing countries, and its adverse effects on mother and baby, can make pregnancy unpleasant for pregnant women. The effect of anxiety during pregnancy on birth outcomes and children can be a justification for screening of anxious pregnant women in periodic pregnancy care and helping them. In this study, researchers have investigated effects and comparison of group counseling (Cognitive therapy) and interactive lectures on anxiety during pregnancy of primiparas. Methods: The population studied in this semi-experimental trail was nulliparous pregnant women with backgrounds in health care centers in Sari city .They were studied during a period of 3 months from early March to end May 2016. Sample size in this study was 91 patients, who were randomly assigned to three groups: group counseling, interactive lecture, and control group. Demographic questionnaire and Speilberger State –Trait Anxiety Inventory (SPAI) was completed for all three groups after obtaining letter of consent and completing the initial checklist. Then interventions included 4 sessions for group counseling and 4 sessions for interactive lecture which were implemented in two sessions a week. 4 weeks after interventions, Speilberger State – Trait Anxiety Inventory (SPAI), completed by both group counseling and interactive lectures groups again. In control group, the second questionnaire was also completed 4 weeks after completing the initial questionnaire. Data analysis was performed using spss software version 18. At first, the Kalmogorov-Smiranov test was carried out and then chi square tests, Independent t-test, paired t-test, ANOVA test, and Dunnett's post hoc test were applied. Results: Findings show that group counseling and interactive lecture with reducing state and trait anxiety in significant level of P=0/000 contribute to reduction of anxiety in nulliparous pregnant mothers. However, in this study, group counseling was more effective than an interactive lecture in reducing participants' anxiety, but this difference was not significant (P≥0/05). Conclusions: According to the results of this study, it is suggested that by screening of psychological - mental problems of pregnant women in periodic care during pregnancy be considered by revised prenatal care plans and creation of counseling and training units at health centers. Besides owing to the fact that both interactive lecture and group counseling method were effective in reducing anxiety, these methods should be used proportionate to situations and facilities.

Keywords: anxiety, group counseling, cognitive therapy, interactive lecture, nulliparous

Procedia PDF Downloads 268

Authors: Leoba Nyathi, Augustine K. Tugli, Takalani G. Tshitangano

Abstract:

Use of health care services is an effective way of improving maternal and child health outcomes, especially in the rural areas. The study aimed to find out the perceptions of women on factors that affect the utilisation of antenatal care services (ANC) in Mangwe Rural District, Zimbabwe. The study was conducted in Mabunga village which is situated in Mangwe Rural District, Matabeleland South Province, Zimbabwe. A qualitative approach using explorative and descriptive design was adopted for the study. A sample of ten women were chosen from the target population by means of convenience sampling and data was collected through semi-structured interviews. Interviews and discussions were audio-taped, transcribed and coded into themes and subthemes. The study results showed that access factors, socio-cultural factors, demographic factors, quality of care and knowledge about antenatal care services were the major factors affecting utilisation of ANC services in Mangwe Rural District. It was discovered that the geographical location of the village to the health care centres has a great impact on utilisation of services. All the women did not initiate ANC services as recommended and they also did not adhere to the number of times they were supposed to visit the health care centres. The findings concluded that women have the knowledge about ANC and they all attended at least once during their last pregnancy. However, inconsistencies in attendance were shown due to access, socio-cultural and demographic factors.

Keywords: antenatal care services, women, utilisation, affect, factors, perceptions

Procedia PDF Downloads 338

Authors: N. Szczepanska, B. Kudlak, G. Yotova, S. Tsakovski, J. Namiesnik

Abstract:

In the scientific literature related to the widely understood issue of packaging materials designed to have contact with food (food contact materials), there is much information on raw materials used for their production, as well as their physiochemical properties, types, and parameters. However, not much attention is given to the issues concerning migration of toxic substances from packaging and its actual influence on the health of the final consumer, even though health protection and food safety are the priority tasks. The goal of this study was to estimate the impact of particular foodstuff packaging type, food production, and storage conditions on the degree of leaching of potentially toxic compounds and endocrine disruptors to foodstuffs using the acute toxicity test Microtox and XenoScreen YES YAS assay. The selected foodstuff packaging materials were metal cans used for fish storage and tetrapak. Five stimulants respectful to specific kinds of food were chosen in order to assess global migration: distilled water for aqueous foods with a pH above 4.5; acetic acid at 3% in distilled water for acidic aqueous food with pH below 4.5; ethanol at 5% for any food that may contain alcohol; dimethyl sulfoxide (DMSO) and artificial saliva were used in regard to the possibility of using it as an simulation medium. For each packaging three independent variables (temperature and contact time) factorial design simulant was performed. Xenobiotics migration from epoxy resins was studied at three different temperatures (25°C, 65°C, and 121°C) and extraction time of 12h, 48h and 2 weeks. Such experimental design leads to 9 experiments for each food simulant as conditions for each experiment are obtained by combination of temperature and contact time levels. Each experiment was run in triplicate for acute toxicity and in duplicate for estrogen disruption potential determination. Multi-factor analysis of variation (MANOVA) was used to evaluate the effects of the three main factors solvent, temperature (temperature regime for cup), contact time and their interactions on the respected dependent variable (acute toxicity or estrogen disruption potential). From all stimulants studied the most toxic were can and tetrapak lining acetic acid extracts that are indication for significant migration of toxic compounds. This migration increased with increase of contact time and temperature and justified the hypothesis that food products with low pH values cause significant damage internal resin filling. Can lining extracts of all simulation medias excluding distilled water and artificial saliva proved to contain androgen agonists even at 25°C and extraction time of 12h. For tetrapak extracts significant endocrine potential for acetic acid, DMSO and saliva were detected.

Keywords: food packaging, extraction, migration, toxicity, biotest

Procedia PDF Downloads 156

Authors: Delphine Vendryes, Dushyanth Sekhar, Baojia Tong, Matthew Theisen, Chester Curme

Abstract:

Much of the data that inform the decisions of governments, corporations and individuals are harvested from unstructured documents. Data extraction is defined here as a process that turns non-machine-readable information into a machine-readable format that can be stored, for instance, in a database. In financial services, introducing more automation in data extraction pipelines is a major challenge. Information sought by financial data consumers is often buried within vast bodies of unstructured documents, which have historically required thorough manual extraction. Automated solutions provide faster access to non-machine-readable datasets, in a context where untimely information quickly becomes irrelevant. Data quality standards cannot be compromised, so automation requires high data integrity. This multifaceted task is broken down into smaller steps: ingestion, table parsing (detection and structure recognition), text analysis (entity detection and disambiguation), schema-based record extraction, user feedback incorporation. Selected intermediary steps are phrased as machine learning problems. Solutions leveraging cutting-edge approaches from the fields of computer vision (e.g. table detection) and natural language processing (e.g. entity detection and disambiguation) are proposed.

Keywords: computer vision, entity recognition, finance, information retrieval, machine learning, natural language processing

Procedia PDF Downloads 86

Authors: Tamer El-Messery, Teresa Sanchez-Moya, Ruben Lopez-Nicolas, Gaspar Ros, Esmat Aly

Abstract:

Olive leaves (OLs), the main by-product of the olive oil industry, have a considerable amount of phenolic compounds. The exploitation of these compounds represents the current trend in food processing. In this study, OLs polyphenols were microencapsulated with polycaprolactone (PCL) and utilized in formulating novel functional yoghurt. PCL-microcapsules were characterized by scanning electron microscopy, and Fourier transform infrared spectrometry analysis. Their total phenolic (TPC), total flavonoid (TFC) contents, and antioxidant activities (DPPH, FRAP, ABTS), and polyphenols bioaccessibility were measured after oral, gastric, and intestinal steps of in vitro digestion. The four yoghurt formulations (containing 0, 25, 50, and 75 mg of PCL-microsphere/100g yoghurt) were evaluated for their pH, acidity, syneresis viscosity, and color during storage. In vitro digestion significantly affected the phenolic composition in non-encapsulated extract while had a lower impact on encapsulated phenolics. Higher protection was provided for encapsulated OLs extract, and their higher release was observed at the intestinal phase. Yoghurt with PCL-microsphere had lower viscosity, syneresis, and color parameters, as compared to control yoghurt. Thus, OLs represent a valuable and cheap source of polyphenols which can be successfully applied, in microencapsulated form, to formulate functional yoghurt.

Keywords: yoghurt quality attributes, olive leaves, phenolic and flavonoids compounds, antioxidant activity, polycaprolactone as microencapsulant

Procedia PDF Downloads 115

Authors: Samson Olusegun Apantaku, Adetayo K. Aromolaran, Giyatt Hammed

Abstract:

The study assessed the use of participatory research methods among Federal University of Agriculture Abeokuta, Nigeria (FUNAAB) researchers. Simple random sampling technique was used to select one hundred and twenty respondents from the study area. Data were collected using a questionnaire. Data collected were subjected to descriptive and inferential statistical analyses. Results showed that 75.8% of the respondents were males while only 21.3% were female. The mean age of the respondents was 38.8 years and most (77.5%) of them were married. 15% of the respondents were in professorial cadre, 21.7% and 20% of the respondents were senior lecturers/fellow and lecturer/research fellow I&II respectively. The results further revealed that 93.3% of the respondents were aware of participatory research methods and 82.5% of the respondents have utilized it before. The average period of usage was 2.7 years and participation by consultation (86.7%) and interactive participation (76.7%) were mostly used. Most (94.2%) indicated that fund was the major hindrance to the use of participatory research methods. The result of correlation analysis showed that there was significant relationship between the years of research experience, designation post (status) of the respondents and usage of participatory research methods (r = 0.034, 0.031, p < 0.05). The study concluded that most of the researchers were aware of and used participatory research methods, which could influence the quality of their research or make it acceptable to the end users. It was recommended that more funds should be made available and accessible for participatory research. All researchers should be trained and encouraged to make use of participatory research methods in their research activities so as to achieve effective research and capacity building that could enhance adoption of technologies and increase agricultural production in the country. Farmers’ capacity to participate in agricultural research should also be enhanced.

Keywords: participatory research, participatory research methods, awareness, utilization

Procedia PDF Downloads 385

Authors: Muhammad Mohsin, Mir Md Abdus Salam, Pertti Pulkkinen, Ari Pappinen

Abstract:

Soil polluted with elevated level of nickel (Ni) concentration may cause severe hazards to humans and forest ecosystems, for example, by polluting underground water reserves, affecting food quality and by reducing agricultural productivity. The present study investigated the phytoextraction ability of Salix schwerinii, enhanced with an application of the N100 (11-amino-1-hydroxyundecylidene) chelate. N100 has proved to be a non-toxic, low risk of leaching, environmentally friendly and easily biodegradable chelate that has a potential for metal chelation. The Salix were grown in garden soil that was also amended with nickel (Ni; 150 mg kg⁻¹). Multiple doses of N100 were applied to the treatments as follows: Ni + N100 1.2 g and Ni+ N100 2.4 g. Furthermore, N100 doses were also repeated with the control soil. The effect of N100 on height growth, biomass, and the accumulation of Ni in Salix in polluted soils was studied. In this study, N100 application was found to be effective in enhancing height and biomass growth under polluted treatments. Total reflection X-ray fluorescence (TXRF) spectrometry was used to determine the concentration of Ni in the Salix tissues. The total Ni concentrations in the soils amended with N100 increased substantially by up to 324% as compared to the control. The Ni translocation factor (TF) and bioconcentration factor (BF) values for S. schwerinii increased with the application of N100 as varied from 0.45–1.25 and 0.80‒1.50, respectively. This study revealed that S. schwerinii is suitable for the phytoextraction of Ni-contaminated soils.

Keywords: bisphosphonic acid, nickel, phytoextraction, Salix

Procedia PDF Downloads 121

Authors: Roya Yumul, Chse, Ofelia Loani Elvir Lazo, David Chernobylsky, Omar Durra

Abstract:

Background: Preoperative anxiety has been shown to be caused by the fear associated with surgical and anesthetic complications; however, the current gold standard for assessing patient anxiety, the STAI, is problematic to use in the preoperative setting given the duration and concentration required to complete the 40-item extensive questionnaire. Our primary aim in the study is to investigate the correlation of the Visual Facial Anxiety Scale (VFAS) and Numerical Verbal Rating Scale (NVRS) to State-Trait Anxiety Inventory (STAI) to determine the optimal anxiety scale to use in the perioperative setting. Methods: A clinical study of patients undergoing various surgeries was conducted utilizing each of the preoperative anxiety scales. Inclusion criteria included patients undergoing elective surgeries, while exclusion criteria included patients with anesthesia contraindications, inability to comprehend instructions, impaired judgement, substance abuse history, and those pregnant or lactating. 293 patients were analyzed in terms of demographics, anxiety scale survey results, and anesthesia data via Spearman Coefficients, Chi-Squared Analysis, and Fischer’s exact test utilized for comparison analysis. Results: Statistical analysis showed that VFAS had a higher correlation to STAI than NVRS (rs=0.66, p<0.0001 vs. rs=0.64, p<0.0001). The combined VFAS-Categorization Scores showed the highest correlation with the gold standard (rs=0.72, p<0.0001). Subgroup analysis showed similar results. STAI evaluation time (247.7 ± 54.81 sec) far exceeds VFAS (7.29 ± 1.61 sec), NVRS (7.23 ± 1.60 sec), and Categorization scales (7.29 ± 1.99 sec). Patients preferred VFAS (54.4%), Categorization (11.6%), and NVRS (8.8%). Anesthesiologists preferred VFAS (63.9%), NVRS (22.1%), and Categorization Scales (14.0%). Of note, the top five causes of preoperative anxiety were determined to be waiting (56.5%), pain (42.5%), family concerns (40.5%), no information about surgery (40.1%), or anesthesia (31.6%). Conclusions: Combined VFAS-Categorization Score (VCS) demonstrates the highest correlation to the gold standard, STAI. Both VFAS and Categorization tests also take significantly less time than STAI, which is critical in the preoperative setting. Among both patients and anesthesiologists, VFAS was the most preferred scale. This forms the basis of the Yumul FACES Anxiety Scale, designed for quick quantization and assessment in the preoperative setting while maintaining a high correlation to the golden standard. Additional studies using the formulated Yumul FACES Anxiety Scale are merited.

Keywords: numerical verbal anxiety scale, preoperative anxiety, state-trait anxiety inventory, visual facial anxiety scale

Procedia PDF Downloads 106

Authors: Marcin Jakiel, Maria Kurek, Karolina Gutkowska, Sylwia Sanakiewicz, Dominika Stolarczyk, Jakub Batko, Rafał Jakiel, Mateusz K. Hołda

Abstract:

Proper imaging of the interventricular septum during endocavital lead implantation is essential for successful procedure. The interventricular septum is located oblique to the 3 main body planes and forms angles of 44.56° ± 7.81°, 45.44° ± 7.81°, 62.49° (IQR 58.84° - 68.39°) with the sagittal, frontal and transverse planes, respectively. The optimal left anterior oblique (LAO) projection is to have the septum aligned along the radiation beam and will be obtained for an angle of 53.24° ± 9,08°, while the best visualization of the septal surface in the right anterior oblique (RAO) projection is obtained by using an angle of 45.44° ± 7.81°. In addition, the RAO angle (p=0.003) and the septal slope to the transverse plane (p=0.002) are larger in the male group, but the LAO angle (p=0.003) and the dihedral angle that the septum forms with the sagittal plane (p=0.003) are smaller, compared to the female group. Analyzing the optimal RAO angle in cross-sections lying at the level of the connections of the septum with the free wall of the right ventricle from the front and back, we obtain slightly smaller angle values, i.e. 41.11° ± 8.51° and 43.94° ± 7.22°, respectively. As the septum is directed leftward in the apical region, the optimal RAO angle for this area decreases (16.49° ± 7,07°) and does not show significant differences between the male and female groups (p=0.23). Within the right ventricular apex, there is a cavity formed by the apical segment of the interventricular septum and the free wall of the right ventricle with a depth of 12.35mm (IQR 11.07mm - 13.51mm). The length of the septum measured in longitudinal section, containing 4 heart cavities, is 73.03mm ± 8.06mm. With the left ventricular septal wall formed by the interventricular septum in the apical region at a length of 10.06mm (IQR 8.86 - 11.07mm) already lies outside the right ventricle. Both mentioned lengths are significantly larger in the male group (p<0.001). For proper imaging of the septum from the right ventricular side, an oblique position of the visualization devices is necessary. Correct determination of the RAO and LAO angle during the procedure allows to improve the procedure performed, and possible modification of the visual field when moving in the anterior, posterior and apical directions of the septum will avoid complications. Overlooking the change in the direction of the interventricular septum in the apical region and a significant decrease in the RAO angle can result in implantation of the lead into the free wall of the right ventricle with less effective pacing and even complications such as wall perforation and cardiac tamponade. The demonstrated gender differences can also be helpful in setting the right projections. A necessary addition to the analysis will be a description of the area of the ventricular septum, which we are currently working on using autopsy material.

Keywords: anatomical variability, angle, electrocardiological procedure, intervetricular septum

Procedia PDF Downloads 73

Authors: Jiang Yuqi

Abstract:

Aims: The aim is to analyze the facilitators and barriers of family resilience in cancer patients based on the theoretical domain framework, provide a basis for intervention in the family resilience of cancer patients, and identify the progress and enlightenment of existing intervention projects. Methods: NVivo software was used to code the influencing factors using the framework of 14 theoretical domains as primary nodes; secondary nodes were then refined using thematic analysis, and specific influencing factors were aggregated and analyzed for evaluator reliability. Data sources: PubMed, Embase, CINAHL, Web of Science, Cochrane Library, MEDLINE, CNKI, and Wanfang (search dates: from construction to November 2023). Results: A total of 35 papers were included, with 142 coding points across 14 theoretical domains and 38 secondary nodes. The three most relevant theoretical domains are social influences (norms), the environment and resources, and emotions (mood). The factors with the greatest impact were family support, mood, confidence and beliefs, external support, quality of life, economic circumstances, family adaptation, coping styles with illness, and management. Conclusion: The factors influencing family resilience in cancer patients cover most of the theoretical domains in the Theoretical Domains Framework and are cross-cutting, multi-sourced, and complex. Further in-depth exploration of the key factors influencing family resilience is necessary to provide a basis for intervention research.

Keywords: cancer, survivors, family resilience, theoretical domains framework, literature review

Procedia PDF Downloads 13

Authors: Yananda Siraphatthada

Abstract:

The current study was the succession of a previous study on value added of recycling business management. Its aims are to 1) explore conditions on how to increasing value add of Thai recycling business, and 2) exam the implementation of the 3-staged plan (short, medium, and long term), suggested by the former study, to increase value added of the recycling business as immediate mechanisms to accelerate government operation. Quantitative and qualitative methods were utilized in this research. A qualitative research consisted of in-depth interviews and focus group discussions. Responses were obtained from owners of the waste separation plants, and recycle shops, as well as officers in relevant governmental agencies. They were randomly selected via Quota Sampling. Data was analyzed via content analysis. The sample used for quantitative method consisted of 1,274 licensed recycling operators in eight provinces. The operators were randomly stratified via sampling method. Data were analyzed via descriptive statistics frequency, percentage, average (mean), and standard deviation. The study recommended three-staged plan: short, medium, and long terms. The plan included the development of logistics, the provision of quality market/plants, the amendment of recycling rules/regulation, the restructuring recycling business, the establishment of green-purchasing recycling center, support for the campaigns run by the International Green Purchasing Network (IGPN), conferences/workshops as a public forum to share insights among experts/concern people.

Keywords: strategies, value added, recycle, business

Procedia PDF Downloads 206

Authors: D. Karibasavaraja, Ramesh M.R., Sufiyan Ahmed, Noyonika M.R., Sameeksha A. V., Mamatha J., Samiksha S. Urs

Abstract:

This research paper gives an overview of the experimental analysis of natural fibers with polymer composite. The whole world is concerned about conserving the environment. Henceforth, the demand for natural and decomposable materials is increasing. The application of natural fibers is widely used in aerospace for manufacturing aircraft bodies, and ship construction in navy fields. Based on the literature review, researchers and scientists are replacing synthetic fibers with natural fibers. The selection of these fibers mainly depends on lightweight, easily available, and economical and has its own physical and chemical properties and many other properties that make them a fine quality fiber. The pineapple fiber has desirable properties of good mechanical strength, high cellulose content, and fiber length. Hybrid composite was prepared using different proportions of pineapple fiber and banana fiber, and their ratios were varied in 90% polypropylene mixed with 5% banana fiber and 5% pineapple fiber, 85% polypropylene mixed with 7.5% banana fiber and 7.5% pineapple fiber and 80% polypropylene mixed with 10% banana fiber and 10% pineapple fiber. By impact experimental analysis, we concluded that the combination of 90% polypropylene and 5% banana fiber and 5% pineapple fiber exhibits a higher toughness value with mechanical strength. We also conducted scanning electron microscopy (SEM) analysis which showed better fiber orientation bonding between the banana and pineapple fibers with polypropylene composites. The main aim of the present research is to evaluate the properties of pineapple fiber and banana fiber reinforced with hybrid polypropylene composites.

Keywords: toughness, fracture, impact strength, banana fibers, pineapple fibers, tensile strength, SEM analysis

Procedia PDF Downloads 113

Authors: Aaditya U. Jhamb

Abstract:

Due to the current energy crisis that many countries are battling, energy-efficient buildings are the subject of extensive research in the modern technological era because of growing worries about energy consumption and its effects on the environment. The paper explores 8 factors that help determine energy efficiency for a building: (relative compactness, surface area, wall area, roof area, overall height, orientation, glazing area, and glazing area distribution), with Tsanas and Xifara providing a dataset. The data set employed 768 different residential building models to anticipate heating and cooling loads with a low mean squared error. By optimizing these characteristics, machine learning algorithms may assess and properly forecast a building's heating and cooling loads, lowering energy usage while increasing the quality of people's lives. As a result, the paper studied the magnitude of the correlation between these input factors and the two output variables using various statistical methods of analysis after determining which input variable was most closely associated with the output loads. The most conclusive model was the Decision Tree Regressor, which had a mean squared error of 0.258, whilst the least definitive model was the Isotonic Regressor, which had a mean squared error of 21.68. This paper also investigated the KNN Regressor and the Linear Regression, which had to mean squared errors of 3.349 and 18.141, respectively. In conclusion, the model, given the 8 input variables, was able to predict the heating and cooling loads of a residential building accurately and precisely.

Keywords: energy efficient buildings, heating load, cooling load, machine learning models

Procedia PDF Downloads 69

Authors: Roman Graf, Sergiu Gordea, Heather M. Ryan

Abstract:

This paper presents an approach for the classification of an unstructured format description for identification of file formats. The main contribution of this work is the employment of data mining techniques to support file format selection with just the unstructured text description that comprises the most important format features for a particular organisation. Subsequently, the file format indentification method employs file format classifier and associated configurations to support digital preservation experts with an estimation of required file format. Our goal is to make use of a format specification knowledge base aggregated from a different Web sources in order to select file format for a particular institution. Using the naive Bayes method, the decision support system recommends to an expert, the file format for his institution. The proposed methods facilitate the selection of file format and the quality of a digital preservation process. The presented approach is meant to facilitate decision making for the preservation of digital content in libraries and archives using domain expert knowledge and specifications of file formats. To facilitate decision-making, the aggregated information about the file formats is presented as a file format vocabulary that comprises most common terms that are characteristic for all researched formats. The goal is to suggest a particular file format based on this vocabulary for analysis by an expert. The sample file format calculation and the calculation results including probabilities are presented in the evaluation section.

Keywords: data mining, digital libraries, digital preservation, file format

Procedia PDF Downloads 472

Authors: Sanjeev Sharma

Abstract:

We are living in the information age. Information is not only important to an individual but also to researchers, scientists, academicians and all others who are doing work in their respective fields. The 21st century which is also known as the electronic era has brought several changes in the mechanism of the libraries in their working environment. In the present scenario, acquisition of information resources and implementation of new strategies have brought a revolution in the library’s structures and their principles. In the digital era, the role of the library has become important as new information is coming at every minute. The knowledge society wants to seek information at their desk. The libraries are managing electronic services and web-based information sources constantly in a democratic way. The basic objective of every library is to save the time of user which is based on the quality and user-orientation of services. With the advancement of information communication and technology, the libraries should pay more devotion to the development trends of the information society that would help to adjust their development strategies and information needs of the knowledge society. The knowledge-based society demands to re-define the position and objectives of all the institutions which work with information, knowledge, and culture. The situation is the era of digital India is changing at a fast speed. Everyone wants information 24x7 and libraries have been recognized as one of the key elements for open access to information, which is crucial not only to individual but also to democratic knowledge-based information society. Libraries are especially important now a day the whole concept of education is focusing more and more independent e-learning and their acting. The citizens of India must be able to find and use the relevant information. Here we can see libraries enter the stage: The essential features of libraries are to acquire, organize, store and retrieve for use and preserve publicly available material irrespective of the print as well as non-print form in which it is packaged in such a way that, when it is needed, it can be found and put to use.

Keywords: knowledge, society, libraries, culture

Procedia PDF Downloads 120

Authors: Magdalena Escamilla Quintal, Thelma Cetina Canto, Cecilia Aguilar Ortega

Abstract:

Due to the importance that people represent for companies, the setting of a clear control of the risks that threaten the health and the material and financial resources of workers is essential. It is irrelevant if the company is a small and medium-sized enterprise (SME) or a large multinational, or if it is in the construction or service sector. The risk prevention importance is related to a constitutional and human right that all people have; working in a risk-free environment to prevent accidents or illnesses that may influence their quality of life and the tranquility of their family. Therefore, the objective of this study was to determine the level of psychosocial risks (physical and emotional) of the employees of an SME. The participants of this study were 186 employees of a productive sector SME; 151 men and 35 women, all with an average age of 31.77 years. Their seniority inside the SME was between one month and 19.91 years. Ninety-six workers were from the production area, 28 from the management area, as well as 25 from the sales area and 40 from the supplies area. Ninety-three workers were found in Uman, 78 in Playa del Carmen, 11 in Cancun and seven in Cd. del Carmen. We found a statistically significant relationship between the burnout variable and the engagement and psychosomatic complaints as well as between the variables of sex, burnout and psychosomatic complaints. We can conclude that, for benefit of the SME, that there are low levels of burnout and psychosomatic complaints, the women experience major levels of burnout and the men show major levels of psychosomatic complaints. The findings, contributions, limitations and future proposals will be analyzed.

Keywords: psychosocial risks, SME, burnout, engagement, psychosomatic complaints

Procedia PDF Downloads 322

Authors: Piyakajornkul T., Noppiboon S., Hochareon L., Kitsubun P.

Abstract:

Nowadays, DNA vaccines become an interesting subject in the third vaccine generation. The platform of DNA vaccines production has been developed and its downstream process becomes challenging due to the quality of the products in terms of purity and percentage of supercoiled DNA. To overcome these challenges, tangential flow filtration (TFF), which is involved in the purification process, could be used since it provides effective separation of impurity prior to performing further purification steps. However, operating conditions of TFF is varied based on several factors such as sizes of target particle and impurities, a concentration of solution as well as a concentration polarization on the membrane surface. In this study, pVAX1/lacZ was used as a model of TFF optimization in order to prevent a concentration polarization that can lead to the membrane fouling and also minimize a diafiltration volume while maintaining the maximum permeate flux resulting in proper operating times and buffer volume. By using trans membrane pressure (TMP) excursion method, feed flow rates and TMP were varied. The results showed a correlation of permeate flux with TMP where the maximum volume concentration factor reached 2.5 times of the initial volume when feed flow rate and TMP were 7 liters/m²/min and 1 bar, respectively. It was optimal operating conditions before TFF system undergone pressure independent regime. In addition, the diafiltration volume was 14 times of the concentrated volume prior to performing a further anion chromatography process.

Keywords: concentration polarization, DNA vaccines, optimization, permeate flux, pressure dependent, tangential flow filtration (TFF), trans membrane pressure (TMP)

Procedia PDF Downloads 122

Authors: Alberto Sanchidrián, José A. Parra, Jesús Alonso, Julián Pecharromán, Antonia Pacios, Consuelo Huerta

Abstract:

Glass is a commonly used material in building; there is not a unique design solution as plates with a different number of layers and interlayers may be used. In most façades, a security glazing have to be used according to its performance in the impact pendulum. The European Standard EN 12600 establishes an impact test procedure for classification under the point of view of the human security, of flat plates with different thickness, using a pendulum of two tires and 50 kg mass that impacts against the plate from different heights. However, this test does not replicate the actual dimensions and border conditions used in building configurations and so the real stress distribution is not determined with this test. The influence of different boundary conditions, as the ones employed in construction sites, is not well taking into account when testing the behaviour of safety glazing and there is not a detailed procedure and criteria to determinate the glass resistance against human impact. To reproduce the actual boundary conditions on site, when needed, the pendulum test is arranged to be used "in situ", with no account for load control, stiffness, and without a standard procedure. Fracture stress of small and large glass plates fit a Weibull distribution with quite a big dispersion so conservative values are adopted for admissible fracture stress under static loads. In fact, test performed for human impact gives a fracture strength two or three times higher, and many times without a total fracture of the glass plate. Newest standards, as for example DIN 18008-4, states for an admissible fracture stress 2.5 times higher than the ones used for static and wing loads. Now two working areas are open: a) to define a standard for the ‘in situ’ test; b) to prepare a laboratory procedure that allows testing with more real stress distribution. To work on both research lines a laboratory that allows to test medium size specimens with different border conditions, has been developed. A special steel frame allows reproducing the stiffness of the glass support substructure, including a rigid condition used as reference. The dynamic behaviour of the glass plate and its support substructure have been characterized with finite elements models updated with modal tests results. In addition, a new portable impact machine is being used to get enough force and direction control during the impact test. Impact based on 100 J is used. To avoid problems with broken glass plates, the test have been done using an aluminium plate of 1000 mm x 700 mm size and 10 mm thickness supported on four sides; three different substructure stiffness conditions are used. A detailed control of the dynamic stiffness and the behaviour of the plate is done with modal tests. Repeatability of the test and reproducibility of results prove that procedure to control both, stiffness of the plate and the impact level, is necessary.

Keywords: glass plates, human impact test, modal test, plate boundary conditions

Procedia PDF Downloads 281

Authors: Kumud Singh, Janvin Itteera, Priti Ukarde, Sanjay Malhotra, P. PMarathe, Ayan Bandyopadhay, Rakesh Meena, Vikram Rawat, L. M. Joshi

Abstract:

Application of Permanent magnet technology to high frequency miniature klystron tubes to be utilized for space applications improves the efficiency and operational reliability of these tubes. But nevertheless the task of generating magnetic focusing forces to eliminate beam divergence once the beam crosses the electrostatic focusing regime and enters the drift region in the RF section of the tube throws several challenges. Building a high quality magnet focusing lens to meet beam optics requirement in cathode gun and RF interaction region is considered to be one of the critical issues for these high frequency miniature tubes. In this paper, electromagnetic design and particle trajectory studies in combined electric and magnetic field for optimizing the magnetic circuit using 3D finite element method (FEM) analysis software is presented. A rectangular configuration of the magnet was constructed to accommodate apertures for input and output waveguide sections and facilitate coupling of electromagnetic fields into the input klystron cavity and out from output klystron cavity through coupling loops. Prototype lenses have been built and have been tested after integration with the klystron tube. We discuss the design requirements and challenges, and the results from beam transmission of the prototype lens.

Keywords: beam transmission, Brillouin, confined flow, miniature klystron

Procedia PDF Downloads 416

Authors: Oranso T. Mahlangi, Bhekie B. Mamba

Abstract:

The occurrence of trace organic compounds (TOrCs) in water has raised health concerns for living organisms. The majority of TorCs, including pharmaceuticals and volatile organic compounds, are poorly monitored, partly due to the high cost of analysis and less strict water quality guidelines in South Africa. Therefore, the removal of TorCs is important to guarantee safe potable water. In this study, ZnO nanoparticles were fabricated in situ in polyethersulfone (PES) polymer solutions. This was followed by membrane synthesis using the phase inversion technique. Techniques such as FTIR, Raman, SEM, AFM, EDS, and contact angle measurements were used to characterize the membranes for several physicochemical properties. The membranes were then evaluated for their efficiency in treating pharmaceutical wastewater and resistance to organic (sodium alginate) and protein (bovine serum albumin) fouling. EDS micrographs revealed uniform distribution of ZnO nanoparticles within the polymer matrix, while SEM images showed uniform fingerlike structures. The addition of ZnO increased membrane roughness as well as hydrophilicity (which in turn improved water fluxes). The membranes poorly rejected monovalent and divalent salts (< 10%), making them resistant to flux decline due to concentration polarization effects. However, the membranes effectively removed carbamazepine, caffeine, sulfamethoxazole, ibuprofen, and naproxen by over 50%. ZnO PES membranes were resistant to organic and protein fouling compared to the neat membrane. ZnO PES ultrafiltration membranes may provide a solution in the reclamation of wastewater.

Keywords: trace organic compounds, pharmaceuticals, membrane fouling, wastewater reclamation

Procedia PDF Downloads 114

Authors: An-Na Li, Ying-Yu Chen, Chang-Kuang Chiou

Abstract:

Food tourism is one of the growing industries and areas of interest in the tourism industry today. The Destination Marketing Organizations (DMOs) are aware of the importance of gastronomy in order to stimulate local and regional economic development. From the heritage and cultural aspects, gastronomy is becoming a more important part of the cultural heritage of region and countries. Heritage destinations provide culinary heritage, which fits the current interest in traditional food, and cuisine is part of a general desire for authentic experiences. However, few studies have empirically examining food tourist’s behavior. This study examined the effects of cuisine experience, emotions and tourists’ revisit intentions. A total of 402 individuals responded to the on-site survey in the historic town of Lu-Kang in Taiwan. The results indicated that tourists’ cuisine experience include place flavor, media recommended local learning, life transfer and interpersonal share. In addition, cuisine experience had significant impacts on emotions, which in turn cuisine experience and emotions had significant effects on tourists’ revisit intentions. The findings suggested that the cuisine experience is a multi- dimensions construct. On the other hands, the good quality of cuisine experience could evoke tourists’ positive emotions and it plays a significant role in promote tourist revisit intentions and word of mouth. Implications for theory and practice are discussed.

Keywords: culinary tourism, cuisine experience, emotions, revisit intentions

Procedia PDF Downloads 375

Authors: Ying-Jung Hsieh, Angela S. Huang, Chu-Ming Chiu, Yu-Min Chou, Chin-Hui Yang

Abstract:

Background and Objectives: Hepatitis A is primarily acquired by the fecal-oral route through person-to-person contact or ingestion of contaminated food or water. During 2010 to 2014, an average of 83 cases of locally-acquired disease was reported to Taiwan’s notifiable disease system. Taiwan Centers for Disease Control (TCDC) identified an outbreak of acute hepatitis A which began in June 2015. Of the 126 cases reported in 2015, 103 (82%) cases were reported during June–December and 95 cases (92%) of them were male. The average age of all male cases was 31 years (median, 29 years; range, 15–76 years). Among the 95 male cases, 49 (52%) were also infected with HIV, and all reported to have had sex with other men. To control this outbreak, TCDC launched a free hepatitis A vaccination program in January 2016 for close contacts of confirmed hepatitis A cases, including family members, sexual partners, and household contacts. Effect of the vaccination program was evaluated. Methods: All cases of hepatitis A reported to the National Notifiable Disease Surveillance System were included. A case of hepatitis A was defined as a locally-acquired disease in a person who had acute clinical symptoms include fever, malaise, loss of appetite, nausea or abdominal discomfort compatible with hepatitis, and tested positive for anti-HAV IgM during June 2015 to June 2016 in Taiwan. The rate of case accumulation was calculated using a simple regression model. Results: During January–June 2016, there were 466 cases of hepatitis A reported; of the 243 (52%) who were also infected with HIV, 232 (95%) had a history of having sex with men. Of the 346 cases that were followed up, 259 (75%) provided information on contacts but only 14 (5%) of them provided the name of their sexual partners. Among the 602 contacts reported, 349 (58%) were family members, 14 (2%) were sexual partners, and 239 (40%) were other household contacts. Among the 602 contacts eligible for free hepatitis A vaccination, 440 (73%) received the vaccine. There were 87 (25%) cases that refused to disclose their close contacts. The average case accumulation rate during January–June 2016 was 21.7 cases per month, which was 6.8 times compared to the average case accumulation rate during June–December 2015 of 3.2 cases per month. Conclusions: Despite vaccination program aimed to provide free hepatitis A vaccine to close contacts of hepatitis A patients, the outbreak continued and even gained momentum in transmission. Refusal by hepatitis A patients to provide names of their close contacts and rejection of contacts to take the hepatitis A vaccine may have contributed to the poor effect of the program. Targeted vaccination efforts of all MSM may be needed to control the outbreak among this population in the short term. In the long term, universal vaccination program is needed to prevent the infection of hepatitis A.

Keywords: hepatitis A, HIV, men who have sex with men, vaccination

Procedia PDF Downloads 230

Authors: Hanan Bin Nakhi, Asaad M. Albadrawi, Maged Al Shahat, ‎Entesar Mandani

Abstract:

Background:‎ Kawasaki disease (KD) is one of the most common vasculitis of childhood. ‎It is considered the leading cause of acquired heart disease in children. The ‎peak age of occurrence is 6 to 24 months, with 80% of affected children being ‎less than 5 years old. There are only a few reports of KD in infants younger ‎than 6 months. Infants had a higher incidence of atypical KD and of coronary ‎artery complications. This case report from Kuwait will reinforce considering ‎atypical KD in case of sepsis like condition with negative cultures and ‎unresponding to systemic antibiotics. Early diagnosis allows early treatment ‎with intravenous immune globulin (IVIG) and so decreases the incidence of ‎cardiac aneurysm.‎ Case Report:‎ A 2 month old female infant, product of full term normal delivery to ‎consanguineous parents, presented with fever and poor feeding. She was ‎admitted and treated as urinary tract infection as her urine routine revealed ‎pyurea. The baby continued to have persistent fever and hypoactivity inspite ‎of using intravenous antibiotics. Latter, she developed non purulent ‎conjunctivitis, skin mottling, oedema of the face / lower limb and was treated ‎in intensive care unit as a case of septic shock. In spite of her partial general ‎improvement, she continued to look unwell, hypoactive and had persistent ‎fever. Septic work up, metabolic, and immunologic screen were negative. KD ‎was suspected when the baby developed polymorphic erythematous rash and ‎noticed to have peeling of skin at perianal area and periangular area of the ‎fingers of the hand and feet. IVIG was given in dose of 2 gm/kg/day in single ‎dose and aspirin 100 mg/kg/day in four divided doses. The girl showed marked ‎clinical improvement. The fever subsided dramatically and the level acute ‎phase reactant markedly decreased but the platelets count increased to ‎‎1600000/mm3. Echo cardiography showed mild dilatation of mid right ‎coronary artery. Aspirin was continued in a dose of 5 mg/kg/d till repeating ‎cardiac echo. ‎Conclusion:‎ A high index of suspicion of KD must be maintained in young infants with ‎prolonged unexplained fever. Accepted criteria should be less restrictive to ‎allow early diagnosis of a typical KD in infants less than 6 months of age. ‎Timely appropriate treatment with IVIG is essential to avoid severe coronary ‎sequels.‎

Keywords: Kawasaki disease, atypical Kawasaki disease, infantile Kawasaki disease, hypo activity‎ ‎

Procedia PDF Downloads 279