Search results for: incompetency to stand trial
Commenced in January 2007
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Edition: International
Paper Count: 1342

Search results for: incompetency to stand trial

1072 Multiparticulate SR Formulation of Dexketoprofen Trometamol by Wurster Coating Technique

Authors: Bhupendra G. Prajapati, Alpesh R. Patel

Abstract:

The aim of this research work is to develop sustained release multi-particulates dosage form of Dexketoprofen trometamol, which is the pharmacologically active isomer of ketoprofen. The objective is to utilization of active enantiomer with minimal dose and administration frequency, extended release multi-particulates dosage form development for better patience compliance was explored. Drug loaded and sustained release coated pellets were prepared by fluidized bed coating principle by wurster coater. Microcrystalline cellulose as core pellets, povidone as binder and talc as anti-tacking agents were selected during drug loading while Kollicoat SR 30D as sustained release polymer, triethyl citrate as plasticizer and micronized talc as an anti-adherent were used in sustained release coating. Binder optimization trial in drug loading showed that there was increase in process efficiency with increase in the binder concentration. 5 and 7.5%w/w concentration of Povidone K30 with respect to drug amount gave more than 90% process efficiency while higher amount of rejects (agglomerates) were observed for drug layering trial batch taken with 7.5% binder. So for drug loading, optimum Povidone concentration was selected as 5% of drug substance quantity since this trial had good process feasibility and good adhesion of the drug onto the MCC pellets. 2% w/w concentration of talc with respect to total drug layering solid mass shows better anti-tacking property to remove unnecessary static charge as well as agglomeration generation during spraying process. Optimized drug loaded pellets were coated for sustained release coating from 16 to 28% w/w coating to get desired drug release profile and results suggested that 22% w/w coating weight gain is necessary to get the required drug release profile. Three critical process parameters of Wurster coating for sustained release were further statistically optimized for desired quality target product profile attributes like agglomerates formation, process efficiency, and drug release profile using central composite design (CCD) by Minitab software. Results show that derived design space consisting 1.0 to 1.2 bar atomization air pressure, 7.8 to 10.0 gm/min spray rate and 29-34°C product bed temperature gave pre-defined drug product quality attributes. Scanning Image microscopy study results were also dictate that optimized batch pellets had very narrow particle size distribution and smooth surface which were ideal properties for reproducible drug release profile. The study also focused on optimized dexketoprofen trometamol pellets formulation retain its quality attributes while administering with common vehicle, a liquid (water) or semisolid food (apple sauce). Conclusion: Sustained release multi-particulates were successfully developed for dexketoprofen trometamol which may be useful to improve acceptability and palatability of a dosage form for better patient compliance.

Keywords: dexketoprofen trometamol, pellets, fluid bed technology, central composite design

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1071 A Double PWM Source Inverter Technique with Reduced Leakage Current for Application on Standalone Systems

Authors: Md.Noman Habib Khan, M. S. Tajul Islam, T. S. Gunawan, M. Hasanuzzaman

Abstract:

The photovoltaic (PV) panel with no galvanic isolation system is well-known technique in the world which is effective and deliver power with enhanced efficiency. The PV generation presented here is for stand-alone system installed in remote areas when as the resulting power gets connected to electronic load installation instead of being tied to the grid. Though very small, even then transformer-less topology is shown to be with leakage in pico-ampere range. By using PWM technique PWM, leakage current in different situations is shown. The results that are demonstrated in this paper show how the pico-ampere current is reduced to femto-ampere through use of inductors and capacitors of suitable values of inductor and capacitors with the load.

Keywords: photovoltaic (PV) panel, duty cycle, pulse duration modulation (PDM), leakage current

Procedia PDF Downloads 510
1070 An A-Star Approach for the Quickest Path Problem with Time Windows

Authors: Christofas Stergianos, Jason Atkin, Herve Morvan

Abstract:

As air traffic increases, more airports are interested in utilizing optimization methods. Many processes happen in parallel at an airport, and complex models are needed in order to have a reliable solution that can be implemented for ground movement operations. The ground movement for aircraft in an airport, allocating a path to each aircraft to follow in order to reach their destination (e.g. runway or gate), is one process that could be optimized. The Quickest Path Problem with Time Windows (QPPTW) algorithm has been developed to provide a conflict-free routing of vehicles and has been applied to routing aircraft around an airport. It was subsequently modified to increase the accuracy for airport applications. These modifications take into consideration specific characteristics of the problem, such as: the pushback process, which considers the extra time that is needed for pushing back an aircraft and turning its engines on; stand holding where any waiting should be allocated to the stand; and runway sequencing, where the sequence of the aircraft that take off is optimized and has to be respected. QPPTW involves searching for the quickest path by expanding the search in all directions, similarly to Dijkstra’s algorithm. Finding a way to direct the expansion can potentially assist the search and achieve a better performance. We have further modified the QPPTW algorithm to use a heuristic approach in order to guide the search. This new algorithm is based on the A-star search method but estimates the remaining time (instead of distance) in order to assess how far the target is. It is important to consider the remaining time that it is needed to reach the target, so that delays that are caused by other aircraft can be part of the optimization method. All of the other characteristics are still considered and time windows are still used in order to route multiple aircraft rather than a single aircraft. In this way the quickest path is found for each aircraft while taking into account the movements of the previously routed aircraft. After running experiments using a week of real aircraft data from Zurich Airport, the new algorithm (A-star QPPTW) was found to route aircraft much more quickly, being especially fast in routing the departing aircraft where pushback delays are significant. On average A-star QPPTW could route a full day (755 to 837 aircraft movements) 56% faster than the original algorithm. In total the routing of a full week of aircraft took only 12 seconds with the new algorithm, 15 seconds faster than the original algorithm. For real time application, the algorithm needs to be very fast, and this speed increase will allow us to add additional features and complexity, allowing further integration with other processes in airports and leading to more optimized and environmentally friendly airports.

Keywords: a-star search, airport operations, ground movement optimization, routing and scheduling

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1069 Clinical Trial of VEUPLEXᵀᴹ TBI Assay to Help Diagnose Traumatic Brain Injury by Quantifying Glial Fibrillary Acidic Protein and Ubiquitin Carboxy-Terminal Hydrolase L1 in the Serum of Patients Suspected of Mild TBI by Fluorescence Immunoassay

Authors: Moon Jung Kim, Guil Rhim

Abstract:

The clinical sensitivity of the “VEUPLEXTM TBI assay”, a clinical trial medical device, in mild traumatic brain injury was 28.6% (95% CI, 19.7%-37.5%), and the clinical specificity was 94.0% (95% CI, 89.3%). -98.7%). In addition, when the results analyzed by marker were put together, the sensitivity was higher when interpreting the two tests together than the two tests, UCHL1 and GFAP alone. Additionally, when sensitivity and specificity were analyzed based on CT results for the mild traumatic brain injury patient group, the clinical sensitivity for 2 CT-positive cases was 50.0% (95% CI: 1.3%-98.7%), and 19 CT-negative cases. The clinical specificity for cases was 68.4% (95% CI: 43.5% - 87.4%). Since the low clinical sensitivity for the two CT-positive cases was not statistically significant due to the small number of samples analyzed, it was judged necessary to secure and analyze more samples in the future. Regarding the clinical specificity analysis results for 19 CT-negative cases, there were a large number of patients who were actually clinically diagnosed with mild traumatic brain injury but actually received a CT-negative result, and about 31.6% of them showed abnormal results on VEUPLEXTM TBI assay. Although traumatic brain injury could not be detected in 31.6% of the CT scans, the possibility of actually suffering a mild brain injury could not be ruled out, so it was judged that this could be confirmed through follow-up observation of the patient. In addition, among patients with mild traumatic brain injury, CT examinations were not performed in many cases because the symptoms were very mild, but among these patients, about 25% or more showed abnormal results in the VEUPLEXTM TBI assay. In fact, no damage is observed with the naked eye immediately after traumatic brain injury, and traumatic brain injury is not observed even on CT. But in some cases, brain hemorrhage may occur (delayed cerebral hemorrhage) after a certain period of time, so the patients who did show abnormal results on VEUPLEXTM TBI assay should be followed up for the delayed cerebral hemorrhage. In conclusion, it was judged that it was difficult to judge mild traumatic brain injury with the VEUPLEXTM TBI assay only through clinical findings without CT results, that is, based on the GCS value. Even in the case of CT, it does not detect all mild traumatic brain injury, so it is difficult to necessarily judge that there is no traumatic brain injury, even if there is no evidence of traumatic brain injury in CT. And in the long term, more patients should be included to evaluate the usefulness of the VEUPLEXTM TBI assay in the detection of microscopic traumatic brain injuries without using CT.

Keywords: brain injury, traumatic brain injury, GFAP, UCHL1

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1068 Evaluation of a Piecewise Linear Mixed-Effects Model in the Analysis of Randomized Cross-over Trial

Authors: Moses Mwangi, Geert Verbeke, Geert Molenberghs

Abstract:

Cross-over designs are commonly used in randomized clinical trials to estimate efficacy of a new treatment with respect to a reference treatment (placebo or standard). The main advantage of using cross-over design over conventional parallel design is its flexibility, where every subject become its own control, thereby reducing confounding effect. Jones & Kenward, discuss in detail more recent developments in the analysis of cross-over trials. We revisit the simple piecewise linear mixed-effects model, proposed by Mwangi et. al, (in press) for its first application in the analysis of cross-over trials. We compared performance of the proposed piecewise linear mixed-effects model with two commonly cited statistical models namely, (1) Grizzle model; and (2) Jones & Kenward model, used in estimation of the treatment effect, in the analysis of randomized cross-over trial. We estimate two performance measurements (mean square error (MSE) and coverage probability) for the three methods, using data simulated from the proposed piecewise linear mixed-effects model. Piecewise linear mixed-effects model yielded lowest MSE estimates compared to Grizzle and Jones & Kenward models for both small (Nobs=20) and large (Nobs=600) sample sizes. It’s coverage probability were highest compared to Grizzle and Jones & Kenward models for both small and large sample sizes. A piecewise linear mixed-effects model is a better estimator of treatment effect than its two competing estimators (Grizzle and Jones & Kenward models) in the analysis of cross-over trials. The data generating mechanism used in this paper captures two time periods for a simple 2-Treatments x 2-Periods cross-over design. Its application is extendible to more complex cross-over designs with multiple treatments and periods. In addition, it is important to note that, even for single response models, adding more random effects increases the complexity of the model and thus may be difficult or impossible to fit in some cases.

Keywords: Evaluation, Grizzle model, Jones & Kenward model, Performance measures, Simulation

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1067 Predicting Growth of Eucalyptus Marginata in a Mediterranean Climate Using an Individual-Based Modelling Approach

Authors: S.K. Bhandari, E. Veneklaas, L. McCaw, R. Mazanec, K. Whitford, M. Renton

Abstract:

Eucalyptus marginata, E. diversicolor and Corymbia calophylla form widespread forests in south-west Western Australia (SWWA). These forests have economic and ecological importance, and therefore, tree growth and sustainable management are of high priority. This paper aimed to analyse and model the growth of these species at both stand and individual levels, but this presentation will focus on predicting the growth of E. Marginata at the individual tree level. More specifically, the study wanted to investigate how well individual E. marginata tree growth could be predicted by considering the diameter and height of the tree at the start of the growth period, and whether this prediction could be improved by also accounting for the competition from neighbouring trees in different ways. The study also wanted to investigate how many neighbouring trees or what neighbourhood distance needed to be considered when accounting for competition. To achieve this aim, the Pearson correlation coefficient was examined among competition indices (CIs), between CIs and dbh growth, and selected the competition index that can best predict the diameter growth of individual trees of E. marginata forest managed under different thinning regimes at Inglehope in SWWA. Furthermore, individual tree growth models were developed using simple linear regression, multiple linear regression, and linear mixed effect modelling approaches. Individual tree growth models were developed for thinned and unthinned stand separately. The developed models were validated using two approaches. In the first approach, models were validated using a subset of data that was not used in model fitting. In the second approach, the model of the one growth period was validated with the data of another growth period. Tree size (diameter and height) was a significant predictor of growth. This prediction was improved when the competition was included in the model. The fit statistic (coefficient of determination) of the model ranged from 0.31 to 0.68. The model with spatial competition indices validated as being more accurate than with non-spatial indices. The model prediction can be optimized if 10 to 15 competitors (by number) or competitors within ~10 m (by distance) from the base of the subject tree are included in the model, which can reduce the time and cost of collecting the information about the competitors. As competition from neighbours was a significant predictor with a negative effect on growth, it is recommended including neighbourhood competition when predicting growth and considering thinning treatments to minimize the effect of competition on growth. These model approaches are likely to be useful tools for the conservations and sustainable management of forests of E. marginata in SWWA. As a next step in optimizing the number and distance of competitors, further studies in larger size plots and with a larger number of plots than those used in the present study are recommended.

Keywords: competition, growth, model, thinning

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1066 Cotton Transplantation as a Practice to Escape Infection with Some Soil-Borne Pathogens

Authors: E. M. H. Maggie, M. N. A. Nazmey, M. A. Abdel-Sattar, S. A. Saied

Abstract:

A successful trial of transplanting cotton is reported. Seeds grown in trays for 4-5 weeks in an easily prepared supporting medium such as peat moss or similar plant waste are tried. Careful transplanting of seedlings, with root system as intact as possible, is being made in the permanent field. The practice reduced damping-off incidence rate and allowed full winter crop revenues. Further work is needed to evaluate certain parameters such as growth curve, flowering curve, and yield at economic bases.

Keywords: cotton, transplanting cotton, damping-off diseases, environment sciences

Procedia PDF Downloads 335
1065 Electrochemical Study of Copper–Tin Alloy Nucleation Mechanisms onto Different Substrates

Authors: Meriem Hamla, Mohamed Benaicha, Sabrine Derbal

Abstract:

In the present work, several materials such as M/glass (M = Pt, Mo) were investigated to test their suitability for studying the early nucleation stages and growth of copper-tin clusters. It was found that most of these materials stand as good substrates to be used in the study of the nucleation and growth of electrodeposited Cu-Sn alloys from aqueous solution containing CuCl2, SnCl2 as electroactive species and Na3C6H5O7 as complexing agent. Among these substrates, Pt shows instantaneous models followed by 3D diffusion-limited growth. On the other hand, the electrodeposited copper-tin thin films onto Mo substrate followed progressive nucleation. The deposition mechanism of the Cu-Sn films has been studied using stationary electrochemical techniques (cyclic voltammetery (CV) and chronoamperometry (CA). The structural, morphological and compositional of characterization have been studied using X-ray diffraction (XRD), scanning electron microscopy (SEM) and EDAX techniques respectively.

Keywords: electrodeposition, CuSn, nucleation, mechanism

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1064 Characterization of Sintered Fe-Cr-Mn Powder Mixtures Containing Intermetallics

Authors: A. Yonetken, A. Erol, M. Cakmakkaya

Abstract:

Intermetallic materials are among advanced technology materials that have outstanding mechanical and physical properties for high temperature applications. Especially creep resistance, low density and high hardness properties stand out in such intermetallics. The microstructure, mechanical properties of %88Ni-%10Cr and %2Mn powders were investigated using specimens produced by tube furnace sintering at 900-1300°C temperature. A composite consisting of ternary additions, a metallic phase, Fe ,Cr and Mn have been prepared under Ar shroud and then tube furnace sintered. XRD, SEM (Scanning Electron Microscope), were investigated to characterize the properties of the specimens. Experimental results carried out for composition %88Ni-%10Cr and %2Mn at 1300°C suggest that the best properties as 138,80HV and 6,269/cm3 density were obtained at 1300°C.

Keywords: composite, high temperature, intermetallic, sintering

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1063 Investigation and Comprehensive Benefit Analysis of 11 Typical Polar-Based Agroforestry Models Based on Analytic Hierarchy Process in Anhui Province, Eastern China

Authors: Zhihua Cao, Hongfei Zhao, Zhongneng Wu

Abstract:

The development of polar-based agroforestry was necessary due to the influence of the timber market environment in China, which can promote the coordinated development of forestry and agriculture, and gain remarkable ecological, economic and social benefits. The main agroforestry models of the main poplar planting area in Huaibei plain and along the Yangtze River plain were carried out. 11 typical management models of poplar were selected to sum up: pure poplar forest, poplar-rape-soybean, poplar-wheat-soybean, poplar-rape-cotton, poplar-wheat, poplar-chicken, poplar-duck, poplar-sheep, poplar-Agaricus blazei, poplar-oil peony, poplar-fish, represented by M0-M10, respectively. 12 indexes related with economic, ecological and social benefits (annual average cost, net income, ratio of output to investment, payback period of investment, land utilization ratio, utilization ratio of light energy, improvement and system stability of ecological and production environment, product richness, labor capacity, cultural quality of labor force, sustainability) were screened out to carry on the comprehensive evaluation and analysis to 11 kinds of typical agroforestry models based on analytic hierarchy process (AHP). The results showed that the economic benefit of each agroforestry model was in the order of: M8 > M6 > M9 > M7 > M5 > M10 > M4 > M1 > M2 > M3 > M0. The economic benefit of poplar-A. blazei model was the highest (332, 800 RMB / hm²), followed by poplar-duck and poplar-oil peony model (109, 820RMB /hm², 5, 7226 RMB /hm²). The order of comprehensive benefit was: M8 > M4 > M9 > M6 > M1 > M2 > M3 > M7 > M5 > M10 > M0. The economic benefit and comprehensive benefit of each agroforestry model were higher than that of pure poplar forest. The comprehensive benefit of poplar-A. blazei model was the highest, and that of poplar-wheat model ranked second, while its economic benefit was not high. Next were poplar-oil peony and poplar-duck models. It was suggested that the model of poplar-wheat should be adopted in the plain along the Yangtze River, and the whole cycle mode of poplar-grain, popalr-A. blazei, or poplar-oil peony should be adopted in Huaibei plain, northern Anhui. Furthermore, wheat, rape, and soybean are the main crops before the stand was closed; the agroforestry model of edible fungus or Chinese herbal medicine can be carried out when the stand was closed in order to maximize the comprehensive benefit. The purpose of this paper is to provide a reference for forest farmers in the selection of poplar agroforestry model in the future and to provide the basic data for the sustainable and efficient study of poplar agroforestry in Anhui province, eastern China.

Keywords: agroforestry, analytic hierarchy process (AHP), comprehensive benefit, model, poplar

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1062 Iron Supplementation for Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized-Controlled Trials

Authors: Matthew Cameron, Stephen Yang, Latifa Al Kharusi, Adam Gosselin, Anissa Chirico, Pouya Gholipour Baradari

Abstract:

Background: Iron supplementation has been evaluated in several randomized controlled trials (RCTs) for the potential to increase baseline hemoglobin and decrease the incidence of red blood cell (RBC) transfusion during cardiac surgery. This study's main objective was to evaluate the evidence for iron administration in cardiac surgery patients for its effect on the incidence of perioperative RBC transfusion. Methods: This systematic review protocol was registered with PROSPERO (CRD42020161927) on Dec. 19th, 2019, and was prepared as per the PRISMA guidelines. MEDLINE, EMBASE, CENTRAL, Web of Science databases, and Google Scholar were searched for RCTs evaluating perioperative iron administration in adult patients undergoing cardiac surgery. Each abstract was independently reviewed by two reviewers using predefined eligibility criteria. The primary outcome was perioperative RBC transfusion, with secondary outcomes of the number of RBC units transfused, change in ferritin level, reticulocyte count, hemoglobin, and adverse events, after iron administration. The risk of bias was assessed with the Cochrane Collaboration Risk of Bias Tool, and the primary and secondary outcomes were analyzed with a random-effects model. Results: Out of 1556 citations reviewed, five studies (n = 554 patients) met the inclusion criteria. The use of iron demonstrated no difference in transfusion incidence (RR 0.86; 95% CI 0.65 to 1.13). There was a low heterogeneity between studies (I²=0%). The trial sequential analysis suggested an optimal information size of 1132 participants, which the accrued information size did not reach. Conclusion: The current literature does not support the routine use of iron supplementation before cardiac surgery; however, insufficient data is available to draw a definite conclusion. A critical knowledge gap has been identified, and more robust RCTs are required on this topic.

Keywords: cardiac surgery, iron, iron supplementation, perioperative medicine, meta-analysis, systematic review, randomized controlled trial

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1061 Antifungal Activity of Silver Colloidal Nanoparticles against Phytopathogenic Fungus (Phomopsis sp.) in Soybean Seeds

Authors: J. E. Mendes, L. Abrunhosa, J. A. Teixeira, E. R. de Camargo, C. P. de Souza, J. D. C. Pessoa

Abstract:

Among the many promising nanomaterials with antifungal properties, metal nanoparticles (silver nanoparticles) stand out due to their high chemical activity. Therefore, the aim of this study was to evaluate the effect of silver nanoparticles (AgNPs) against Phomopsis sp. AgNPs were synthesized by silver nitrate reduction with sodium citrate and stabilized with ammonia. The synthesized AgNPs have further been characterized by UV/Visible spectroscopy, Biophysical techniques like Dynamic light scattering (DLS) and Scanning Electron Microscopy (SEM). The average diameter of the prepared silver colloidal nanoparticles was about 52 nm. Absolute inhibitions (100%) were observed on treated with a 270 and 540 µg ml-1 concentration of AgNPs. The results from the study of the AgNPs antifungal effect are significant and suggest that the synthesized silver nanoparticles may have an advantage compared with conventional fungicides.

Keywords: antifungal activity, Phomopsis sp., seeds, silver nanoparticles, soybean

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1060 Effectiveness of a Pasifika Women’s Diabetes Wellness Program (PWDWP) – Co-design With, by and for MāOri and Pasifika Women Living in Queensland

Authors: Heena Akbar, Winnie Niumata, Danielle Gallegos

Abstract:

Type 2 diabetes is a significant public health problem for Māori and Pasifika communities in Queensland, who are experiencing a higher burden of morbidity and mortality from the condition. Despite this higher burden, there are few initiatives that are culturally tailored to improve prevention and management. Modification of personal behaviors through women’s wellness programs aimed at early intervention has been shown to reduce the risk of developing complications in established type 2 diabetes and may reduce hospitalization rates from preventable complications related to this disease. The 24-week Pasifika Women’s Diabetes Wellness Program (PWDWP) was culturally co-designed and co-developed with Māori and Pasifika women with type 2 diabetes through a community-academia partnership in Queensland. Underpinned by Social Cognitive Theory and the Indigenous Pacific Health frameworks to include family culture & spirituality and integrating a collectivist and whānau (family) centered approach to self-care, the program takes into consideration the cultural shame associated with acknowledging the disease and tailors the interventions using talanoa (storytelling or conversation in a relational context) as the key strategy to come to a shared meaning for behavior change. The pilot trial is a 12-week intervention followed by a 12-week follow-up period conducted with 50 women with type 2 diabetes, 25 women who will receive the intervention and 25 women who will receive usual care. The pilot program provides in-person and virtual access to culturally supported prevention and self-management of Māori and Pasifika women with type 2 diabetes with the aim to improve healthy lifestyles and reduce late hospital presentations from diabetes-related complications for better diabetes-related outcomes. This study will test and evaluate the effectiveness of the PWDWP pilot trial in partnership with Māori & Pasifika community organizations and key stakeholders for improved glycated hemoglobin (HbA1c) levels associated with poor management of type 2 diabetes.

Keywords: culturally co-designed intervention, Indigenous methodology, Māori and Pasifika communities, type 2 diabetes self-management

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1059 Household Energy Usage in Nigeria: Emerging Advances for Sustainable Development

Authors: O. A. Akinsanya

Abstract:

This paper presents the emerging trends in household energy usage in Nigeria for sustainable development. The paper relied on a direct appraisal of energy use in the residential sector and the use of a structured questionnaire to establish the usage pattern, energy management measures and emerging advances. The use of efficient appliances, retrofitting, smart building and smart attitude are some of the benefitting measures. The paper also identified smart building, prosumer activities, hybrid energy use, improved awareness, and solar stand-alone street/security lights as the trend and concluded that energy management strategies would result in a significant reduction in the monthly bills and peak loads as well as the total electricity consumption in Nigeria and therefore it is good for sustainable development.

Keywords: household, energy, trends, strategy, sustainable, Nigeria

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1058 Preliminary Short-Term Results of a Population of Patients Treated with Mitraclip Therapy: One Center Experience

Authors: Rossana Taravella, Gilberto M. Cellura, Giuseppe Cirrincione, Salvatore Asciutto, Marco Caruso, Massimo Benedetto, Renato Ciofalo, Giuliana Pace, Salvatore Novo

Abstract:

Objectives: This retrospective analysis sought to evaluate 1-month outcomes and therapy effectiveness of a population of patients treated with MitraClip therapy. We describe in this article the preliminary results of primary effectiveness endpoint. Background: Percutaneous Mitral Repair is being developed to treat severe mitral regurgitation (MR), with increasing real-world cases of functional MR (FMR). In the EVEREST (Endovascular Valve Edge-to-Edge Repair Study)II trial, the percutaneous device showed superior safety but less reduction in MR at 1year. 4-year outcomes from EVEREST II trial showed no difference in the prevalence of moderate-severe and severe MR or mortality at 4years between surgical mitral repair and percutaneous approach. Methods: We analysed retrospectively collected data from one center experience in Italy enrolled from January 2011 to December 2016. The study included 62 patients [mean age 74±11years, 43 men (69%)] with MR of at least grade3+. Most of the patients had functional MR, were in New York Heart Association (NYHA) functional class III or IV, with a large portion (78%) of mild-to-moderate Tricuspid Regurgitation (TR). One or more clips were implanted in 67 procedures (62 patients). Results and Conclusions: Severity of MR was reduced in all successfully treated patients,54(90%) were discharged with MR≤2+ (primary effectiveness endpoint). Clinical 1-month follow-up data showed an improvement in NYHA functional class (42 patients (70%) in NYHA class I-II). 60 of 62 (97 %) successfully treated patients were free from death and mitral valve surgery at 1-month follow-up. MitraClip therapy reduces functional MR with acute MR reduction to <2+ in the great majority of patients, with a large freedom from death, surgery or recurrent MR in a great portion of patients.

Keywords: MitraClip, mitral regurgitation, heart valves, catheter-based therapy

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1057 Response of Full-Scale Room Building Against Blast Loading

Authors: Eid Badshah, Amjad Naseer, Muhammad Ashraf

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In this paper full-scale brick masonry room along with the veranda of a typical school building was subjected to eight successive blast tests with increasing charge weights ranging from 0.5kg to 16.02kg at 3.66m fixed stand-off distance. Pressure-time histories were obtained by data acquisition system from pressure sensors, installed on different points of room as well as veranda columns. The resulting damage pattern of different locations was observed during each test. Weak zones of masonry room were identified. Scaled distances for different damage levels in masonry room were experimentally obtained. The results provided a basis for determining the response of masonry room building against blast loading in a specific threat scenario.

Keywords: peak pressure, composition-B, TNT, pressure sensor, scaled distance, masonry

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1056 Testing the Effectiveness of a Peer Facilitated Body Project Interventions Among Body Dissatisfied Young Women in China: A Randomized Control Trial

Authors: Todd Jackson

Abstract:

In this randomized control trial, we tested the effectiveness of a peer-facilitated version of the Body Project (BP) intervention among body-dissatisfied young women in China. Participants were randomly assigned to a peer-facilitator BP condition (N = 94) versus an educational video minimal intervention control condition (N = 89). Questionnaire measures of two primary outcomes (i.e., disordered eating and body dissatisfaction) and six secondary outcomes (thin-ideal internalization, pressure to be thin, negative affect, body surveillance, body shame, body appreciation and interest in cosmetic surgery) were administered at a pre-treatment baseline, a post-treatment assessment, and at a 12-month follow-up. A series of 2 (Group) x 2 (Time) analyses of variance indicated women in the peer-facilitated BP condition reported significant improvements in primary outcome measures of disordered eating and body dissatisfaction compared to women in the educational video control condition following treatment and at the 12-month follow-up. Furthermore, women in the peer-facilitated BP condition reported significant improvements in measures of body surveillance, body shame and body appreciation) compared to educational video controls that extended to the 12-month follow-up. Finally, although women in the peer-facilitated BP condition showed significant post-treatment improvements in thin-ideal internalization, negative affect, perceived pressure to be thin, and interest in cosmetic surgery compared to video controls, these differences were no longer statistically significant at the 12-month follow-up. In conclusion, findings supported the overall effectiveness of a peer-facilitated group version of the BP as an intervention for reducing disordered eating and several associated risk factors among at-risk young women in China.

Keywords: body project, disordered eating, body dissatisfaction, risk factors, prevention, China

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1055 Effectiveness of Mobile Health Augmented Cardiac Rehabilitation (MCard) on Health-Related Quality of Life among Post-Acute Coronary Syndrome Patients: A Randomized Controlled Trial

Authors: Aliya Hisam, Zia Ul Haq, Sohail Aziz, Patrick Doherty, Jill Pell

Abstract:

Objective: To determine the effectiveness of Mobile health augmented Cardiac rehabilitation (MCard) on health-related quality of life (HRQoL) among post-acute coronary syndrome(post-ACS) patients. Methodology: In a randomized controlled trial, post-ACS patients were randomly allocated (1:1) to an intervention group (received MCard; counseling, empowering with self-monitoring devices, short text messages, in addition to standard post-ACS care) or control group (standard post-ACS care). HRQoL was assessed by generic Short Form-12 and MacNew quality of life myocardial infarction (QLMI) tools. Participants were followed for 24 weeks with data collection and analysis at three-time points (baseline, 12 weeks and 24 weeks). Result: At baseline, 160 patients (80 in each group; mean age 52.66+8.46 years; 126 males, 78.75%) were recruited, of which 121(75.62%) continued and were analyzed at 12-weeks and 119(74.37%) at 24-weeks. The mean SF-12 physical component score significantly improved in the MCard group at 12 weeks follow-up (48.93 vs. control 43.87, p<.001) and 24 weeks (53.52 vs. 46.82 p<.001). The mean SF-12 mental component scores also improved significantly in the MCard group at 12 weeks follow-up (44.84 vs. control 41.40, p<.001) and 24 weeks follow-up (48.95 vs 40.12, p<.001). At 12-and 24-week follow-up, all domains of MacNew QLMI (social, emotional, physical and global) were also statistically significant (p<.001) improved in the MCard group, unlike the control group. Conclusion: MCard is feasible and effective at improving all domains of HRQoL. There was an improvement in physical, mental, social, emotional and global domains among the MCard group in comparison to the control group. The addition of MCard programs to post-ACS standard care may improve patient outcomes and reduce the burden on the health care setting.

Keywords: acute coronary syndrome, mobile health augmented cardiac rehabilitation (MCard), cardiovascular diseases, cardiac rehabilitation, health-related quality of life, short form 12, MacNew QLMI

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1054 Combined Mindfulness and Exercise Intervention for Depressive and Insomnia Symptoms in Chinese Students: A Pilot Randomized Controlled Trial

Authors: Xinli Chi, Xiaoqi Wei

Abstract:

Background: Body-mind theory refers to the concept that the mind and body are interconnected; in this case, combining aerobic exercise and mindfulness-based training may be beneficial for mind-body health; however, there is limited evidence regarding their effects and potential mechanisms among Chinese university students. Therefore, the current study aims to examine the preliminary effects and feasibility of the combined intervention on depressive and insomnia symptoms, as well as to explore the underlying mechanisms. Methods: This is a two-arm pilot study of a randomized, controlled trial. Sixty-one Chinese university students were randomly allocated to 8-week combined intervention group (aerobic exercise plus mindfulness, N = 36) or control group (N = 36). In addition, 8 participants in combined intervention group were later volunteer to engage in semi-structured interview. The Self-Rating Depression Scale (SDS) and the Youth Self-Rating Insomnia Scales (YSIS) were used to measure depressive and insomnia symptoms, respectively. The intervention outcome and feasibility were tested by repeated-measures ANOVA, mediation model, and qualitative analysis. Results: The study included 31 participants in the intervention group and 30 participants in the control group, all of whom completed pre-test and post-test questionnaires. The results of the repeated-measures ANOVA showed that the combined intervention was effective in reducing depressive and insomnia symptoms among university students. Moreover, the mediation analysis suggested that improvement in insomnia symptoms might be a significant mechanism for the combined intervention. Qualitative analysis identified two main themes: “Helpful aspects of mind-body state” (including 7 sub-themes) and “Factors that influence the training effects” (including 3 sub-themes). Conclusions: The study confirmed the preliminary effect and feasibility of the combined intervention of mindfulness and aerobic exercise, while also exploring the potential mechanisms underlying this effect. Additionally, qualitative data provided valuable insights for optimizing future protocols.

Keywords: combined intervention, mindfulness, aerobic exercise, depressive symptoms, insomnia symptoms

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1053 Production of Chromium Matrix Composite Reinforced by WC by Powder Metallurgy

Authors: Ahmet Yonetken, Ayhan Erol

Abstract:

Intermetallic materials advanced technology materials that have outstanding mechanical and physical properties for high temperature applications. Especially creep resistance, low density and high hardness properties stand out in such intermetallics. The microstructure, mechanical properties of %80Cr-%10Ti and %10WC powders were investigated using specimens produced by tube furnace sintering at 1000-1400°C temperature. A composite consisting of ternary additions, a metallic phase, Ti,Cr and WC have been prepared under Ar shroud and then tube furnace sintered. XRD, SEM (Scanning Electron Microscope), were investigated to characterize the properties of the specimens. Experimental results carried out for composition %80Cr-%10Ti and %10WC at 1400°C suggest that the best properties as 292HV and 5,34g/cm3 density were obtained at 1400°C.

Keywords: ceramic-metal, composites, powder metallurgy, sintering

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1052 Methylphenidate and Placebo Effect on Brain Activity and Basketball Free Throw: A Randomized Controlled Trial

Authors: Mohammad Khazaei, Reza Rostami, Hasan Gharayagh Zandi, Rouhollah Basatnia, Mahbubeh Ghayour Najafabadi

Abstract:

Objective: Methylphenidate has been demonstrated to enhance attention and cognitive processes, and placebo treatments have also been found to improve attention and cognitive processes. Additionally, methylphenidate may have positive effects on motion perception and sports performance. Nevertheless, additional research is needed to fully comprehend the neural mechanisms underlying the effects of methylphenidate and placebo on cognitive and motor functions. Methods: In this randomized controlled trial, 18 young semi-professional basketball players aged 18-23 years were randomly and equally assigned to either a Ritalin or Placebo group. The participants performed 20 consecutive free throws; their scores were recorded on a 0-3 scale. The participants’ brain activity was recorded using electroencephalography (EEG) for 5 minutes seated with their eyes closed. The Ritalin group received a 10 mg dose of methylphenidate, while the Placebo group received a 10mg dose of placebo. The EEG was obtained 90 minutes after the drug was administere Results: There was no significant difference in the absolute power of brain waves between the pre-test and post-tests in the Placebo group. However, in the Ritalin group, a significant difference in the absolute power of brain waves was observed in the Theta band (5-6 Hz) and Beta band (21-30 Hz) between pre- and post-tests in Fp2, F8, and Fp1. In these areas, the absolute power of Beta waves was higher during the post-test than during the pre-test. The Placebo group showed a more significant difference in free throw scores than the Ritalin group. Conclusions: In conclusion, these results suggest that Ritalin effect on brain activity in areas associated with attention and cognitive processes, as well as improve basketball free throws. However, there was no significant placebo effect on brain activity performance, but it significantly affected the improvement of free throws. Further research is needed to fully understand the effects of methylphenidate and placebo on cognitive and motor functions.

Keywords: methylphenidate, placebo effect, electroencephalography, basketball free throw

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1051 The Theory of Number "0"

Authors: Iryna Shevchenko

Abstract:

The science of mathematics was originated at the order of count of objects and subsequently for the measurement of size and quality of objects using the logical or abstract means. The laws of mathematics are based on the study of absolute values. The number 0 or "nothing" is the purely logical (as the opposite to absolute) value as the "nothing" should always assume the space for the something that had existed there; otherwise the "something" would never come to existence. In this work we are going to prove that the number "0" is the abstract (logical) and not an absolute number and it has the absolute value of “∞” (infinity). Therefore, the number "0" might not stand in the row of numbers that symbolically represents the absolute values, as it would be the mathematically incorrect. The symbolical value of number "0" in the row of numbers could be represented with symbol "∞" (infinity). As a result, we have the mathematical row of numbers: epsilon, ...4, 3, 2, 1, ∞. As the conclusions of the theory of number “0” we presented the statements: multiplication and division by fractions of numbers is illegal operation and the mathematical division by number “0” is allowed.

Keywords: illegal operation of division and multiplication by fractions of number, infinity, mathematical row of numbers, theory of number “0”

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1050 Improving Junior Doctor Induction Through the Use of Simple In-House Mobile Application

Authors: Dmitriy Chernov, Maria Karavassilis, Suhyoun Youn, Amna Izhar, Devasenan Devendra

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Introduction and Background: A well-structured and comprehensive departmental induction improves patient safety and job satisfaction amongst doctors. The aims of our Project were as follows: 1. Assess the perceived preparedness of junior doctors starting their rotation in Acute Medicine at Watford General Hospital. 2. Develop a supplemental Induction Guide and Pocket reference in the form of an iOS mobile application. 3. To collect feedback after implementing the mobile application following a trial period of 8 weeks with a small cohort of junior doctors. Materials and Methods: A questionnaire was distributed to all new junior trainees starting in the department of Acute Medicine to assess their experience of current induction. A mobile Induction application was developed and trialled over a period of 8 weeks, distributed in addition to the existing didactic induction session. After the trial period, the same questionnaire was distributed to assess improvement in induction experience. Analytics data were collected with users’ consent to gauge user engagement and identify areas of improvement of the application. A feedback survey about the app was also distributed. Results: A total of 32 doctors used the application during the 8-week trial period. The application was accessed 7259 times in total, with the average user spending a cumulative of 37 minutes 22 seconds on the app. The most used section was Clinical Guidelines, accessed 1490 times. The App Feedback survey revealed positive reviews: 100% of participants (n=15/15) responded that the app improved their overall induction experience compared to other placements; 93% (n=14/15) responded that the app improved overall efficiency in completing daily ward jobs compared to previous rotations; and 93% (n=14/15) responded that the app improved patient safety overall. In the Pre-App and Post-App Induction Surveys, participants reported: a 48% improvement in awareness of practical aspects of the job; a 26% improvement of awareness on locating pathways and clinical guidelines; a 40% reduction of feelings of overwhelmingness. Conclusions and recommendations: This study demonstrates the importance of technology in Medical Education and Clinical Induction. The mobile application average engagement time equates to over 20 cumulative hours of on-the-job training delivered to each user, within an 8-week period. The most used and referred to section was clinical guidelines. This shows that there is high demand for an accessible pocket guide for this type of material. This simple mobile application resulted in a significant improvement in feedback about induction in our Department of Acute Medicine, and will likely impact workplace satisfaction. Limitations of the application include: post-app surveys had a small number of participants; the app is currently only available for iPhone users; some useful sections are nested deep within the app, lacks deep search functionality across all sections; lacks real time user feedback; and requires regular review and updates. Future steps for the app include: developing a web app, with an admin dashboard to simplify uploading and editing content; a comprehensive search functionality; and a user feedback and peer ratings system.

Keywords: mobile app, doctor induction, medical education, acute medicine

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1049 Catchment Nutrient Balancing Approach to Improve River Water Quality: A Case Study at the River Petteril, Cumbria, United Kingdom

Authors: Nalika S. Rajapaksha, James Airton, Amina Aboobakar, Nick Chappell, Andy Dyer

Abstract:

Nutrient pollution and their impact on water quality is a key concern in England. Many water quality issues originate from multiple sources of pollution spread across the catchment. The river water quality in England has improved since 1990s and wastewater effluent discharges into rivers now contain less phosphorus than in the past. However, excess phosphorus is still recognised as the prevailing issue for rivers failing Water Framework Directive (WFD) good ecological status. To achieve WFD Phosphorus objectives, Wastewater Treatment Works (WwTW) permit limits are becoming increasingly stringent. Nevertheless, in some rural catchments, the apportionment of Phosphorus pollution can be greater from agricultural runoff and other sources such as septic tanks. Therefore, the challenge of meeting the requirements of watercourses to deliver WFD objectives often goes beyond water company activities, providing significant opportunities to co-deliver activities in wider catchments to reduce nutrient load at source. The aim of this study was to apply the United Utilities' Catchment Systems Thinking (CaST) strategy and pilot an innovative permitting approach - Catchment Nutrient Balancing (CNB) in a rural catchment in Cumbria (the River Petteril) in collaboration with the regulator and others to achieve WFD objectives and multiple benefits. The study area is mainly agricultural land, predominantly livestock farms. The local ecology is impacted by significant nutrient inputs which require intervention to meet WFD obligations. There are a range of Phosphorus inputs into the river, including discharges from wastewater assets but also significantly from agricultural contributions. Solely focusing on the WwTW discharges would not have resolved the problem hence in order to address this issue effectively, a CNB trial was initiated at a small WwTW, targeting the removal of a total of 150kg of Phosphorus load, of which 13kg were to be reduced through the use of catchment interventions. Various catchment interventions were implemented across selected farms in the upstream of the catchment and also an innovative polonite reactive filter media was implemented at the WwTW as an alternative to traditional Phosphorus treatment methods. During the 3 years of this trial, the impact of the interventions in the catchment and the treatment works were monitored. In 2020 and 2022, it respectively achieved a 69% and 63% reduction in the phosphorus level in the catchment against the initial reduction target of 9%. Phosphorus treatment at the WwTW had a significant impact on overall load reduction. The wider catchment impact, however, was seven times greater than the initial target when wider catchment interventions were also established. While it is unlikely that all the Phosphorus load reduction was delivered exclusively from the interventions implemented though this project, this trial evidenced the enhanced benefits that can be achieved with an integrated approach, that engages all sources of pollution within the catchment - rather than focusing on a one-size-fits-all solution. Primarily, the CNB approach and the act of collaboratively engaging others, particularly the agriculture sector is likely to yield improved farm and land management performance and better compliance, which can lead to improved river quality as well as wider benefits.

Keywords: agriculture, catchment nutrient balancing, phosphorus pollution, water quality, wastewater

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1048 Stand Alone Multiple Trough Solar Desalination with Heat Storage

Authors: Abderrahmane Diaf, Kamel Benabdellaziz

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Remote arid areas of the vast expanses of the African deserts hold huge subterranean reserves of brackish water resources waiting for economic development. This work presents design guidelines as well as initial performance data of new autonomous solar desalination equipment which could help local communities produce their own fresh water using solar energy only and, why not, contribute to transforming desert lands into lush gardens. The output of solar distillation equipment is typically low and in the range of 3 l/m2/day on the average. This new design with an integrated, water-based, environmentally-friendly solar heat storage system produced 5 l/m2/day in early spring weather. Equipment output during summer exceeded 9 liters per m2 per day.

Keywords: multiple trough distillation, solar desalination, solar distillation with heat storage, water based heat storage system

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1047 Modification of Fick’s First Law by Introducing the Time Delay

Authors: H. Namazi, H. T. N. Kuan

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Fick's first law relates the diffusive flux to the concentration field, by postulating that the flux goes from regions of high concentration to regions of low concentration, with a magnitude that is proportional to the concentration gradient (spatial derivative). It is clear that the diffusion of flux cannot be instantaneous and should be some time delay in this propagation. But Fick’s first law doesn’t consider this delay which results in some errors especially when there is a considerable time delay in the process. In this paper, we introduce a time delay to Fick’s first law. By this modification, we consider that the diffusion of flux cannot be instantaneous. In order to verify this claim an application sample in fluid diffusion is discussed and the results of modified Fick’s first law, Fick’s first law and the experimental results are compared. The results of this comparison stand for the accuracy of the modified model. The modified model can be used in any application where the time delay has considerable value and neglecting its effect reflects in undesirable results.

Keywords: Fick's first law, flux, diffusion, time delay, modified Fick’s first law

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1046 The Effectiveness of Psychosocial Intervention in Reducing Career Anxiety among Nigerian University Students

Authors: Mkpoikanke Sunday Otu

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Introduction: Career anxiety is a common issue among university students, particularly in developing countries like Nigeria. This anxiety can significantly impact students' academic performance, overall well-being, and future career prospects. Therefore, it is crucial to explore effective interventions that can alleviate career anxiety among university students. The primary aim of this study was to determine the effectiveness of a psychosocial intervention in reducing career anxiety among Nigerian university students. The study employed a group randomized trial research design to further analyze the impact on career anxiety. Methodology: A total of 306 university students from various universities in Akwa Ibom State, Nigeria, were recruited for this study. The participants were purposively selected to ensure diversity and represent a range of academic disciplines. A group randomized trial research design was employed, with participants randomly assigned to either the treatment group or the control group. The treatment group received a comprehensive psychosocial intervention, while the control group served as a comparison group. The Career Anxiety Questionnaire (CAQ) was used to assess career anxiety levels among the participants. The CAQ is a validated and reliable tool that assesses various aspects of career-related anxiety, including uncertainty, fear, and self-doubt. It was administered to the participants at baseline (before the intervention), immediately after the intervention, and at follow-up (after the intervention). Results: Data analysis was conducted using statistical techniques, including analysis of variance (ANOVA). The results demonstrated that the treatment group showed a significantly lower mean score of career anxiety compared to the control group (p-value<0.05). This finding suggests that the psychosocial intervention was effective in reducing the career anxiety levels of the participants at post-test and follow-up. Conclusion: The findings of this study provide compelling evidence that psychosocial interventions have a significant impact on the reduction of career anxiety among Nigerian university students. The treatment group demonstrated a significant reduction in career anxiety scores, indicating the effectiveness of this intervention. Additionally, this study highlights the importance of addressing the career anxiety challenges faced by university students. By implementing targeted interventions, educational institutions can play a vital role in supporting the overall well-being and success of their students, both academically and professionally.

Keywords: psychosocial intervention, career anxiety, psychoeducation, university students

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1045 Community Engagement Strategies to Assist with the Development of an RCT Among People Living with HIV

Authors: Joyce K. Anastasi, Bernadette Capili

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Community Engagement Strategies to Assist with the Development of an RCT Among People Living with HIV Our research team focuses on developing and testing protocols to manage chronic symptoms. For many years, our team designed and implemented symptom management studies for people living with HIV (PLWH). We identify symptoms that are not curative and are not adequately controlled by conventional therapies. As an exemplar, we describe how we successfully engaged PLWH in developing and refining our research feasibility protocol for distal sensory peripheral neuropathy (DSP) associated with HIV. With input from PLWH with DSP, our research received National Institutes of Health (NIH) research funding support. Significance: DSP is one of the most common neurologic complications in HIV. It is estimated that DSP affects 21% to 50% of PLWH. The pathogenesis of DSP in HIV is complex and unclear. Proposed mechanisms include cytokine dysregulation, viral protein-produced neurotoxicity, and mitochondrial dysfunction associated with antiretroviral medications. There are no FDA-approved treatments for DSP in HIV. Purpose: Aims: 1) to explore the impact of DSP on the lives of PLWH, 2) to identify patients’ perspectives on successful treatments for DSP, 3) to identify interventions considered feasible and sensitive to the needs of PLWH with DSP, and 4) to obtain participant input for protocol/study design. Description of Process: We conducted a needs assessment with PLWH with DSP. From our needs assessment, we learned from the patients’ perspective detailed descriptions of their symptoms; physical functioning with DSP; self-care remedies tried, and desired interventions. We also asked about protocol scheduling, instrument clarity, study compensation, study-related burdens, and willingness to participate in a randomized controlled trial (RCT) with a placebo and a waitlist group. Implications: We incorporated many of the suggestions learned from the need assessment. We developed and completed a feasibility study that provided us with invaluable information that informed subsequent NIH-funded studies. In addition to our extensive clinical and research experience working with PLWH, learning from the patient perspective helped in developing our protocol and promoting a successful plan for recruitment and retention of study participants.

Keywords: clinical trial development, peripheral neuropathy, traditional medicine, HIV, AIDS

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1044 The Effect of an Occupational Therapy Programme on Sewing Machine Operators

Authors: N. Dunleavy, E. Lovemore, K. Siljeur, D. Jackson, M. Hendricks, M. Hoosain, N. Plastow, S. Marais

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Background: The work requirements of sewing machine operators cause physical and emotional strain. Past ergonomic interventions have been provided to alleviate physical concerns; however, a holistic, multimodal intervention was needed to improve these factors. Aim: The study aimed to examine the effect of an occupational therapy programme on sewing machine operators’ pain, mental health, and productivity within a factory in the South African context. Methods: A pilot randomised control trial was conducted with 22 sewing machine operators within a single factory. Stratified randomisation was used to determine the experimental (EG) and control groups (CG), using measures for pain intensity, level of depression (mental health), and productivity rates as stratification variables. The EG received the multimodal intervention, incorporating education, seating adaptations, and mental health intervention. In three months, the CG will receive the same intervention. Pre- and post-intervention testing have occurred with upcoming three- and six-month follow-ups. Results: Immediate results indicate a statistically significant decrease in pain in both experimental and control groups; no change in productivity scores and depression between the two groups. This may be attributed to external factors. The values for depression further showed no statistical significance between the two groups and within pre-and post-test results. The Statistical Program for Social Sciences (SPSS) version-24 was used as the data analysis testing, where all the tests will be evaluated at a 5% significance level. Contribution of research: The research adds to the body of knowledge informing the Occupational Therapy role in work settings, providing evidence on the effectiveness of workplace-based multimodal interventions. Conclusion: The study provides initial data on the effectiveness of a pilot randomised control trial on pain and mental health in South Africa. Results indicated no quantitative change between the experimental and control groups; however, qualitative data suggest a clinical significance of the findings.

Keywords: ergonomics programme, occupational therapy, sewing machine operators, workplace-based multimodal interventions

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1043 A Qualitative Review and Meta-Analyses of Published Literature Exploring Rates and Reasons Behind the Choice of Elective Caesarean Section in Pregnant Women With No Contraindication to Trial of Labor After One Previous Caesarean Section

Authors: Risheka Suthantirakumar, Eilish Pearson, Jacqueline Woodman

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Background: Previous research has found a variety of rates and reasons for choosing medically unindicated elective repeat cesarean section (ERCS). Understanding the frequency and reasoning of ERCS, especially when unwarranted, could help healthcare professionals better tailor their advice and service. Therefore, our study conducted meta-analyses and qualitative analyses to identify the reasons and rates worldwide for choosing this procedure over the trial of labor after cesarean (TOLAC), also referred to in published literature as vaginal birth after cesarean (VBAC). Methods: We conducted a systematic review of published literature available on PubMed, EMBASE, and science.gov and conducted a blinded peer review process to assess eligibility. Search terms were created in collaboration with experts in the field. An inclusion and exclusion criteria were established prior to reviewing the articles. Included studies were limited to those published in English due to author constraints, although no international boundaries were used in the search. No time limit for the search was used in order to portray changes over time. Results: Our qualitative analyses found five consistent themes across international studies, which were socioeconomic and cultural differences, previous cesarean experience, perceptions of risk with vaginal birth, patients’ perceptions of future benefits, and medical advice and information. Our meta-analyses found variable rates of ERCS across international borders and within national populations. The average rate across all studies was 44% (CI 95% 36-51). Discussion: The studies included in our qualitative analysis demonstrated similar repetitive themes, which give validity to the findings across the studies included. We consider the rate variation across and within national populations to be partially a result of differing inclusion and eligibility assessment between different studies and argue that a proforma be utilized for future research to be comparable.

Keywords: elective cesarean section, VBAC, TOLAC, maternal choice

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