Search results for: initial costs
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 5048

Search results for: initial costs

4958 Recovery of an Area Degraded by Gullies in the Municipality of Monte Alto (SP), Brazil

Authors: Layane Sara Vieira, Paulo Egidio Bernardo, Roberto Saverio Souza Costa

Abstract:

Anthropogenic occupations and agricultural explorations without concern for the preservation and sustainability of the activity result in soil degradation that can make rural activity unfeasible. The objective of this work was to characterize and evaluate the recovery costs of an area degraded by major erosion (gully) in the municipality of Monte Alto (SP). Topographic characterization was carried out by means of a planialtimetric survey with a total station. The contours of the gully, internal area, slope height, contribution area, volume, and costs of operations for the recovery of the gully were delimited. The results obtained showed that the gully has a length of 145.56 m, a maximum width of 36.61 m, and a gap of 19.48 m. The external area of the gully is 1,039.8741 m², and the internal area is 119.3470 m². The calculated volume was 3,282.63 m³. The intervention area for breaking slopes was measured at 8,471.29 m², requiring the construction of 19 terraces in this area, vertically spaced at 2.8 m. The estimated costs for mechanical recovery of the gully were R$ 19,167.84 (US$ 3.657,98).

Keywords: erosion, volumetric assessment, soil degradation, terraces

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4957 Real-World Economic Burden of Musculoskeletal Disorders in Nigeria

Authors: F. Fatoye, C. E. Mbada, T. Gebrye, A. O. Ogunsola, C. Fatoye, O. Oyewole

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Musculoskeletal disorders (MSDs) such as low back pain (LBP), cervical spondylosis (CSPD), sprain, osteoarthritis (OA), and post immobilization stiffness (PIS) have a major impact on individuals, health systems and society in terms of morbidity, long-term disability, and economics. This study estimated the direct and indirect costs of common MSDs in Osun State, Nigeria. A review of medical charts for adult patients attending Physiotherapy Outpatient Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Osun State, Nigeria between 2009 and 2018 was carried out. The occupational class of the patients was determined using the International Labour Classification (ILO). The direct and indirect costs were estimated using a cost-of-illness approach. Physiotherapy related health resource use, and costs of the common MSDs, including consultation fee, total fee charge per session, costs of consumables were estimated. Data were summarised using descriptive statistics mean and standard deviation (SD). Overall, 1582 (Male = 47.5%, Female = 52.5%) patients with MSDs population with a mean age of 47.8 ± 25.7 years participated in this study. The mean (SD) direct costs estimate for LBP, CSPD, PIS, sprain, OA, and other conditions were $18.35 ($17.33), $34.76 ($17.33), $32.13 ($28.37), $35.14 ($44.16), $37.19 ($41.68), and $15.74 ($13.96), respectively. The mean (SD) indirect costs estimate of LBP, CSPD, PIS, sprain, OA, and other MSD conditions were $73.42 ($43.54), $140.57 ($69.31), $128.52 ($113.46), sprain $140.57 ($69.31), $148.77 ($166.71), and $62.98 ($55.84), respectively. Musculoskeletal disorders contribute a substantial economic burden to individuals with the condition and society. The unacceptable economic loss of MSDs should be reduced using appropriate strategies. Further research is required to determine the clinical and cost effectiveness of strategies to improve health outcomes of patients with MSDs. The findings of the present study may assist health policy and decision makers to understand the economic burden of MSDs and facilitate efficient allocation of healthcare resources to alleviate the burden associated with these conditions in Nigeria.

Keywords: economic burden, low back pain, musculoskeletal disorders, real-world

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4956 Public Preferences and Willingness to Pay for Social Health Insurance in Iran: A Discrete Choice Experiment

Authors: Mohammad Ranjbar, Mohammad Bazyar, Blake Angell, Thomas Lung, Yibeltal Assefa

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Background: Current health insurance programs in Iran suffer from low enrolment and are not sufficient to attain the country to universal health coverage (UHC). We hypothesize that improving the enrollment rate and moving towards a more sustainable UHC can be achieved by improving the benefits package and providing new incentives. The objective of this study is to assess public preferences and willingness to pay (WTP) for social health insurance (SHI) in Iran. Methods: A discrete choice experiment (DCE) was conducted in 2021, using a self-administered questionnaire on 500 participants to estimate WTP and determine individual preferences for the SHI in Yazd, Iran. Respondents were presented with an eight-choice set and asked to select their preferred one. In each choice set, scenarios were described by eight attributes with varying levels. The conditional logit regression model was used to analyze the participants' preferences. Willingness to pay for each attribute was also calculated. Results: Most included attributes were significant predictors of the choice of a health insurance package. The maximum coverage of hospitalization costs in the private sector, ancillary services such as glasses, canes, etc., as well as coverage for hospitalization costs in the public sector and drug costs, were the most important determining factors for this choice. Coverage of preventive dental care did not significantly influence respondent choices. Estimating WTP showed that individuals are willing to pay more for higher financial protection, particularly against private sector costs; the WTP to increase the coverage of hospitalization costs in the private sector from 50% to 90% is estimated at 362,068 IR, Rials per month. Conclusion: This study identifies the key factors that the population value with regard to health insurance and the tradeoffs they are willing to make between them. Hospitalization, drugs, and ancillary services were the most important determining factors for their choice. The data suggest that additional resources coming into the Iranian health system might best be prioritized to cover hospitalization and drug costs and those associated with ancillary services.

Keywords: social health insurance, preferences, discrete choice experiment, willingness to pay

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4955 The Effects of Cost-Sharing Contracts on the Costs and Operations of E-Commerce Supply Chains

Authors: Sahani Rathnasiri, Pritee Ray, Sardar M. N. Isalm, Carlos A. Vega-Mejia

Abstract:

This study develops a cooperative game theory-based cost-sharing contract model for a business to consumer (B2C) e-commerce supply chain to minimize the overall supply chain costs and the individual costs within an information asymmetry scenario. The objective of this study is to address the issues of strategic interactions among the key players of the e-commerce supply chain operation, which impedes the optimal operational outcomes. Game theory has been included in the field of supply chain management to resolve strategic decision-making issues; however, most of the studies are limited only to two-echelons of the supply chains. Multi-echelon supply chain optimizations based on game-theoretic models are less explored in the previous literature. This study adopts a cooperative game model to focus on the common payoff of operations and addresses the issues of information asymmetry and coordination of a three-echelon e-commerce supply chain. The cost-sharing contract model integrates operational features such as production, inventory management and distribution with the contract related constraints. The outcomes of the model highlight the importance of maintaining lower operational costs by all players to obtain benefits from the cost-sharing contract. Further, the cost-sharing contract ensures true cost revelation, and hence eliminates the information asymmetry issues among the players. Comparing the results of the contract model with the de-centralized e-commerce supply chain operation further emphasizes that the cost-sharing contract derives Pareto-improved outcomes and minimizes the costs of overall e-commerce supply chain operation.

Keywords: cooperative game theory, cost-sharing contract, e-commerce supply chain, information asymmetry

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4954 Determination of Critical Period for Weed Control in the Second Crop Forage Maize (454 Cultivar)

Authors: Farhad Farahvash, Parya Mobaseri

Abstract:

Weeds control based on their critical period leads to less production costs and risks of wide chemical application of weeds control methods. The present study considered effect of weeds control time (weeds interference after 20, 40 and 60 days, weeds full control, weeds interference and weeds control after 20, 40 and 60 days) on growth and yield of forage maize 454. The experiment based on full-randomized blocks design with three replications was conducted at research farm of Islamic Azad University of Tabriz located at 15th km of East Tabriz in 2013. According to the results, weeds interference after 40 and 60 days as well as weeds control after 20 days prevented from decrease of maize biomass resulted from weeds presence while weeds interference after 20 days, weeds interference and weeds control after 40 and 60 days led respectively to 41.2%, 35%, 25% and 32.5% decrease of forage maize biomass. The weeds-influenced decrease was manifested at different parts of the plant depending on presence period of weeds. Decrease of fresh weight of ear and fresh weight of leaf and stem was observed due to weeds interference after 20 days and weeds interference. If weeds are controlled after 60 days, decrease of ear weight and fresh weight of stem will lead to biomass decrease. Also, if weeds are controlled after 40 days, decrease of fresh weight of maize stems will result in biomass decrease. Ear traits were affected by weeds control treatment. Being affected by treatments of weeds interference after 20 days, weeds non-interference, weeds control after 40 and 60 days, ear length was shortened 29.9 %, 41.4 %, 27.6 % and 37.2 %, respectively. The stem diameter demonstrated a significant decrease although it was only affected by treatments of weeds interference and weeds control after 60 days. Considering results of the present study, generally, it is suggested to control weeds during initial 20-60 days of maize growth in order to prevent undesirable effect of weeds on growth, production and production biomass of maize and decrease of production costs.

Keywords: maize, competition, weed, biomass

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4953 Seedling Emergence and Initial Growth of Different Plants after Trichoderma sp. Inoculation

Authors: Simonida S. Djuric, Timea I. Hajnal Jafari, Dragana R. Stamenov

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The use of plant growth promoting fungi (PGPF) has significantly increased in the last decade mostly due to their multi-level properties, and their expected success as biofertilizers in agriculture. Beneficial fungi with broad-host range undergo long-term interactions with a large variety of plants thereby playing a significant role in managed ecosystems and in the adaptation of crops to global climate changes. Trichoderma spp. are promising fungi toward the development of sustainable agriculture. The aim of our experiment was to investigate the effect of seed inoculation of sunflower, maize, soybean, paprika, melon, and watermelon seeds with Trichoderma sp. on early seed germination energy and initial growth of the plant. The seed inoculation with Trichoderma sp. increased the seedling emergence from 7, 85% in melon to 156,70% in watermelon. The inoculation had the best effect on initial growth of maize shoot (+23,80%) and soybean root (+106,30%). The different response of seed and young plants on Trichoderma sp. inoculation implicate the need for future investigations of successful inoculation systems and modes of their integration in sustainable agriculture production systems.

Keywords: initial growth, inoculation, seedling, Trichoderma sp.

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4952 Estimation of the Effect of Initial Damping Model and Hysteretic Model on Dynamic Characteristics of Structure

Authors: Shinji Ukita, Naohiro Nakamura, Yuji Miyazu

Abstract:

In considering the dynamic characteristics of structure, natural frequency and damping ratio are useful indicator. When performing dynamic design, it's necessary to select an appropriate initial damping model and hysteretic model. In the linear region, the setting of initial damping model influences the response, and in the nonlinear region, the combination of initial damping model and hysteretic model influences the response. However, the dynamic characteristics of structure in the nonlinear region remain unclear. In this paper, we studied the effect of setting of initial damping model and hysteretic model on the dynamic characteristics of structure. On initial damping model setting, Initial stiffness proportional, Tangent stiffness proportional, and Rayleigh-type were used. On hysteretic model setting, TAKEDA model and Normal-trilinear model were used. As a study method, dynamic analysis was performed using a lumped mass model of base-fixed. During analysis, the maximum acceleration of input earthquake motion was gradually increased from 1 to 600 gal. The dynamic characteristics were calculated using the ARX model. Then, the characteristics of 1st and 2nd natural frequency and 1st damping ratio were evaluated. Input earthquake motion was simulated wave that the Building Center of Japan has published. On the building model, an RC building with 30×30m planes on each floor was assumed. The story height was 3m and the maximum height was 18m. Unit weight for each floor was 1.0t/m2. The building natural period was set to 0.36sec, and the initial stiffness of each floor was calculated by assuming the 1st mode to be an inverted triangle. First, we investigated the difference of the dynamic characteristics depending on the difference of initial damping model setting. With the increase in the maximum acceleration of the input earthquake motions, the 1st and 2nd natural frequency decreased, and the 1st damping ratio increased. Then, in the natural frequency, the difference due to initial damping model setting was small, but in the damping ratio, a significant difference was observed (Initial stiffness proportional≒Rayleigh type>Tangent stiffness proportional). The acceleration and the displacement of the earthquake response were largest in the tangent stiffness proportional. In the range where the acceleration response increased, the damping ratio was constant. In the range where the acceleration response was constant, the damping ratio increased. Next, we investigated the difference of the dynamic characteristics depending on the difference of hysteretic model setting. With the increase in the maximum acceleration of the input earthquake motions, the natural frequency decreased in TAKEDA model, but in Normal-trilinear model, the natural frequency didn’t change. The damping ratio in TAKEDA model was higher than that in Normal-trilinear model, although, both in TAKEDA model and Normal-trilinear model, the damping ratio increased. In conclusion, in initial damping model setting, the tangent stiffness proportional was evaluated the most. In the hysteretic model setting, TAKEDA model was more appreciated than the Normal-trilinear model in the nonlinear region. Our results would provide useful indicator on dynamic design.

Keywords: initial damping model, damping ratio, dynamic analysis, hysteretic model, natural frequency

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4951 Finite Element Modeling of Integral Abutment Bridge for Lateral Displacement

Authors: M. Naji, A. R. Khalim, M. Naji

Abstract:

Integral Abutment Bridges (IAB) are defined as simple or multiple span bridges in which the bridge deck is cast monolithically with the abutment walls. This kind of bridges are becoming very popular due to different aspects such as good response under seismic loading, low initial costs, elimination of bearings and less maintenance. However, the main issue related to the analysis of this type of structures is dealing with soil-structure interaction of the abutment walls and the supporting piles. A two-dimensional, non-linear finite element (FE) model of an integral abutment bridge has been developed to study the effect of lateral time history displacement loading on the soil system.

Keywords: integral abutment bridge, soil structure interaction, finite element modeling, soil-pile interaction

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4950 Environmental Impact of Autoclaved Aerated Concrete in Modern Construction: A Case Study from the New Egyptian Administrative Capital

Authors: Esraa A. Khalil, Mohamed N. AbouZeid

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Building materials selection is critical for the sustainability of any project. The choice of building materials has a huge impact on the built environment and cost of projects. Building materials emit huge amount of carbon dioxide (CO2) due to the use of cement as a basic component in the manufacturing process and as a binder, which harms our environment. Energy consumption from buildings has increased in the last few years; a huge amount of energy is being wasted from using unsustainable building and finishing materials, as well as from the process of heating and cooling of buildings. In addition, the construction sector in Egypt is taking a good portion of the economy; however, there is a lack of awareness of buildings environmental impacts on the built environment. Using advanced building materials and different wall systems can help in reducing heat consumption, the project’s initial and long-term costs, and minimizing the environmental impacts. Red Bricks is one of the materials that are being used widely in Egypt. There are many other types of bricks such as Autoclaved Aerated Concrete (AAC); however, the use of Red Bricks is dominating the construction industry due to its affordability and availability. This research focuses on the New Egyptian Administrative Capital as a case study to investigate the potential of the influence of using different wall systems such as AAC on the project’s cost and the environment. The aim of this research is to conduct a comparative analysis between the traditional and most commonly used bricks in Egypt, which is Red Bricks, and AAC wall systems. Through an economic and environmental study, the difference between the two wall systems will be justified to encourage the utilization of uncommon techniques in the construction industry to build more affordable, energy efficient and sustainable buildings. The significance of this research is to show the potential of using AAC in the construction industry and its positive influences. The study analyzes the factors associated with choosing suitable building materials for different projects according to the need and criteria of each project and its nature without harming the environment and wasting materials that could be saved or recycled. The New Egyptian Administrative Capital is considered as the country’s new heart, where ideas regarding energy savings and environmental benefits are taken into consideration. Meaning that, Egypt is taking good steps to move towards more sustainable construction. According to the analysis and site visits, there is a potential in reducing the initial costs of buildings by 12.1% and saving energy by using different techniques up to 25%. Interviews with the mega structures project engineers and managers reveal that they are more open to introducing sustainable building materials that will help in saving the environment and moving towards green construction as well as to studying more effective techniques for energy conservation.

Keywords: AAC blocks, building material, environmental impact, modern construction, new Egyptian administrative capital

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4949 An Audit of Restaging Transurethral Resection of Bladder Tumor (Re-TURBT) Quality in a District General Hospital

Authors: Rizwan Iqbal

Abstract:

Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

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4948 Inventory Management to Minimize Storage Costs and Improve Delivery Time in a Pharmaceutical Industry

Authors: Israel Becerril Rosales, Manuel González De La Rosa, Gerardo Villa Sánchez

Abstract:

In this work, the effects that produce not having a good inventory management is analyzed, in addition of the way that how it affects the storage costs. The research began conducting the historical analysis about stored products, its storage capacity, and distribution. The results were not optimal, since in all its raw materials (RM) have overstocking, the warehouse capacity is only used by 61%, does not have a specific place for each of its RM, causing that the delivery times increases and makes difficult a cyclical inventory. These shortcomings allowed to view and select as design alternatives the inventory ABC, so that depending on the consumption of each RM would be redistributed by using economic amount requested. Also, the Delphi method to ensure the practical applicability of the proposed tool was used, taking in account comments and suggestions of the involved experts, as well as the compliance of NOM-059-SSA1-2015 good manufacturing practices of drug. With the actions implemented, the utilization rate drops of 61% to 32% capacity, it shows that the warehouse was not designed properly due to there is not an industrial engineering area.

Keywords: lead time, improve delivery, storage costs, inventory management

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4947 Clarification of the Essential of Life Cycle Cost upon Decision-Making Process: An Empirical Study in Building Projects

Authors: Ayedh Alqahtani, Andrew Whyte

Abstract:

Life Cycle Cost (LCC) is one of the goals and key pillars of the construction management science because it comprises many of the functions and processes necessary, which assist organisations and agencies to achieve their goals. It has therefore become important to design and control assets during their whole life cycle, from the design and planning phase through to disposal phase. LCCA is aimed to improve the decision making system in the ownership of assets by taking into account all the cost elements including to the asset throughout its life. Current application of LCC approach is impractical during misunderstanding of the advantages of LCC. This main objective of this research is to show a different relationship between capital cost and long-term running costs. One hundred and thirty eight actual building projects in United Kingdom (UK) were used in order to achieve and measure the above-mentioned objective of the study. The result shown that LCC is one of the most significant tools should be considered on the decision making process.

Keywords: building projects, capital cost, life cycle cost, maintenance costs, operation costs

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4946 Infrastructure Sharing Synergies: Optimal Capacity Oversizing and Pricing

Authors: Robin Molinier

Abstract:

Industrial symbiosis (I.S) deals with both substitution synergies (exchange of waste materials, fatal energy and utilities as resources for production) and infrastructure/service sharing synergies. The latter is based on the intensification of use of an asset and thus requires to balance capital costs increments with snowball effects (network externalities) for its implementation. Initial investors must specify ex-ante arrangements (cost sharing and pricing schedule) to commit toward investments in capacities and transactions. Our model investigate the decision of 2 actors trying to choose cooperatively a level of infrastructure capacity oversizing to set a plug-and-play offer to a potential entrant whose capacity requirement is randomly distributed while satisficing their own requirements. Capacity cost exhibits sub-additive property so that there is room for profitable overcapacity setting in the first period. The entrant’s willingness-to-pay for the access to the infrastructure is dependent upon its standalone cost and the capacity gap that it must complete in case the available capacity is insufficient ex-post (the complement cost). Since initial capacity choices are driven by ex-ante (expected) yield extractible from the entrant we derive the expected complement cost function which helps us defining the investors’ objective function. We first show that this curve is decreasing and convex in the capacity increments and that it is shaped by the distribution function of the potential entrant’s requirements. We then derive the general form of solutions and solve the model for uniform and triangular distributions. Depending on requirements volumes and cost assumptions different equilibria occurs. We finally analyze the effect of a per-unit subsidy a public actor would apply to foster such sharing synergies.

Keywords: capacity, cooperation, industrial symbiosis, pricing

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4945 Correlation between Initial Absorption of the Cover Concrete, the Compressive Strength and Carbonation Depth

Authors: Bouzidi Yassine

Abstract:

This experimental work was aimed to characterize the porosity of the concrete cover zone using the capillary absorption test, and establish the links between open porosity characterized by the initial absorption, the compressive strength and carbonation depth. Eight formulations of workability similar made from ordinary Portland cement (CEM I 42.5) and a compound cement (CEM II/B 42.5) four of each type are studied. The results allow us to highlight the effect of the cement type. Indeed, concretes-based cement CEM II/B 42.5 carbonatent approximately faster than concretes-based cement CEM I 42.5. This effect is attributed in part to the lower content of portlandite Ca(OH)2 of concretes-based cement CEM II/B 42.5, but also the impact of the cement type on the open porosity of the cover concrete. The open porosity of concretes-based cement CEM I 42.5 is lower than that of concretes-based cement CEM II/B 42.5. The carbonation depth is a decreasing function of the compressive strength at 28 days and increases with the initial absorption. Through the results obtained, correlations between the quantity of water absorbed in 1 h, the carbonation depth at 180 days and the compressive strength at 28 days were performed in an acceptable manner.

Keywords: initial absorption, cover concrete, compressive strength, carbonation depth

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4944 Influence of Transportation Mode to the Deterioration Rate: Case Study of Food Transport by Ship

Authors: Danijela Tuljak-Suban, Valter Suban

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Food as perishable goods represents a specific and sensitive part in the supply chain theory, since changing of its physical or chemical characteristics considerably influences the approach to stock management. The most delicate phase of this process is transportation, where it becomes difficult to ensure stability conditions that limit the deterioration, since the value of the deterioration rate could be easily influenced by the transportation mode. Fuzzy definition of variables allows taking into account these variations. Furthermore an appropriate choice of the defuzzification method permits to adapt results, as much as possible, to real conditions. In the article will be applied the those methods to the relationship between the deterioration rate of perishable goods and transportation by ship, with the aim: (a) to minimize the total costs function, defined as the sum of the ordering cost, holding cost, disposing cost and transportation costs, and (b) to improve supply chain sustainability by reducing the environmental impact and waste disposal costs.

Keywords: perishable goods, fuzzy reasoning, transport by ship, supply chain sustainability

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4943 Correlation between Nutritional Status and Length of Stay and Hospital Costs in Critical Care and IPD Patients of Somdech Phra Debaratana Medical Center (SDMC), Faculty of Medicine, Ramathibodi Hospital

Authors: Nuttapimon Bhirommuang, Kulapong Jayanama

Abstract:

Background: Prevalence of malnutrition in hospitalized patient is higher than general population. As a result of the unawareness of consequence and the more concerning in the other aspects of care, many patients with high risk of malnutrition are unrecognized. Even if malnutrition has been identified as affecting in many patient outcomes, the impact may differ in each population and group of patients. Objectives: The aims of this study were to examine the association between the nutritional status and the length of stay and hospital costs in hospitalized patients, to investigate the factors related these outcomes and to determine the frequency of malnutrition in hospitals. Method: This retrospective cohort study enrolled all patients aged 15 years old or older and admitted in SDMC, Ramathibodi Hospital between 1st January 2016 and 30th September 2016. The nutritional status assessment by Nutrition Alert Form (NAF) was performed by well-trained nurses in all patients at admission. Baseline characteristics were recorded. Length of stay and hospital costs were collected during their hospitalization. Univariate analysis, nonparametric rank test, Kruskal-Wallis test were used to compare means in the case of nonnormally and noncontinuously distributed data. Chi-square used to analyze categorical variables, the nutritional status and the length of stay and hospital costs and identify possible confounding factors (data were analyzed using SPSS version 18.0). Result: Of the 2,906 patients, 3.9% were severe malnutrition (NAF-C score > 10) and 11.4% were moderate malnutrition (NAF-B score 6 - 10). Both length of stay and hospital costs were found significantly higher in more severe malnutrition group (p < 0.001), NAF = A: 3.21 days, 95% CI 3.06-3.35 and 111,544.25 THB, 95% CI 106,994.41 – 116,094.1; NAF = B: 7.54 days, 95% CI 6.32 – 8.76 and 162,302.4 THB, 95% CI 129,557.88 – 195,046.92; NAF =C: 14.77 days, 95% CI 11.34 – 18.2 and 323,572.11 THB, 95% CI 226,958.1 – 420,096.13 (1 THB = 0.03019 USD). Age of each nutritional status group had also significant increase from NAF A to NAF C (p < 0.001): 55.07, 67.03 and 73.88 years old, respectively. Conclusion: The prevalence of malnutrition in Ramathibodi hospital is voluminous. Severe malnutrition screening by NAF is significantly correlated with worse clinical outcome, especially higher length of stay and hospital costs. Elderly is also a significant factor which correlates with malnutrition. The results of this study could change the awareness of health personnel and the practice protocol. Moreover, the further study concerning nutritional support in high-risk group of malnutrition is ongoing to confirm this hypothesis.

Keywords: malnutrition, NAF, length of stay, hospital costs

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4942 Optimal Perturbation in an Impulsively Blocked Channel Flow

Authors: Avinash Nayak, Debopam Das

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The current work implements the variational principle to find the optimum initial perturbation that provides maximum growth in an impulsively blocked channel flow. The conventional method for studying temporal stability has always been through modal analysis. In most of the transient flows, this modal analysis is still followed with the quasi-steady assumption, i.e. change in base flow is much slower compared to perturbation growth rate. There are other studies where transient analysis on time dependent flows is done by formulating the growth of perturbation as an initial value problem. But the perturbation growth is sensitive to the initial condition. This study intends to find the initial perturbation that provides the maximum growth at a later time. Here, the expression of base flow for blocked channel is derived and the formulation is based on the two dimensional perturbation with stream function representing the perturbation quantity. Hence, the governing equation becomes the Orr-Sommerfeld equation. In the current context, the cost functional is defined as the ratio of disturbance energy at a terminal time 'T' to the initial energy, i.e. G(T) = ||q(T)||2/||q(0)||2 where q is the perturbation and ||.|| defines the norm chosen. The above cost functional needs to be maximized against the initial perturbation distribution. It is achieved with the constraint that perturbation follows the basic governing equation, i.e. Orr-Sommerfeld equation. The corresponding adjoint equation is derived and is solved along with the basic governing equation in an iterative manner to provide the initial spatial shape of the perturbation that provides the maximum growth G (T). The growth rate is plotted against time showing the development of perturbation which achieves an asymptotic shape. The effects of various parameters, e.g. Reynolds number, are studied in the process. Thus, the study emphasizes on the usage of optimal perturbation and its growth to understand the stability characteristics of time dependent flows. The assumption of quasi-steady analysis can be verified against these results for the transient flows like impulsive blocked channel flow.

Keywords: blocked channel flow, calculus of variation, hydrodynamic stability, optimal perturbation

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4941 Determinants of Standard Audit File for Tax Purposes Accounting Legal Obligation Compliance Costs: Empirical Study for Portuguese SMEs of Leiria District

Authors: Isa Raquel Alves Soeiro, Cristina Isabel Branco de Sá

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In Portugal, since 2008, there has been a requirement to export the Standard Audit File for Tax Purposes (SAF-T) standard file (in XML format). This file thus gathers tax-relevant information from a company relating to a specific period of taxation. There are two types of SAF-T files that serve different purposes: the SAF-T of revenues and the SAF-T of accounting, which requires taxpayers and accounting firms to invest in order to adapt the accounting programs to the legal requirements. The implementation of the SAF-T accounting file aims to facilitate the collection of relevant tax data by tax inspectors as support of taxpayers' tax returns for the analysis of accounting records or other information with tax relevance (Portaria No. 321-A/2007 of March 26 and Portaria No. 302/2016 of December 2). The main objective of this research project is to verify, through quantitative analysis, what is the cost of compliance of Small and Medium Enterprises (SME) in the district of Leiria in the introduction and implementation of the tax obligation of SAF-T - Standard Audit File for Tax Purposes of accounting. The information was collected through a questionnaire sent to a population of companies selected through the SABI Bureau Van Dijk database in 2020. Based on the responses obtained to the questionnaire, the companies were divided into two groups: Group 1 -companies who are self-employed and whose main activity is accounting services; and Group 2 -companies that do not belong to the accounting sector. In general terms, the conclusion is that there are no statistically significant differences in the costs of complying with the accounting SAF-T between the companies in Group 1 and Group 2 and that, on average, the internal costs of both groups represent the largest component of the total cost of compliance with the accounting SAF-T. The results obtained show that, in both groups, the total costs of complying with the SAF-T of accounting are regressive, which appears to be similar to international studies, although these are related to different tax obligations. Additionally, we verified that the variables volume of business, software used, number of employees, and legal form explain the differences in the costs of complying with accounting SAF-T in the Leiria district SME.

Keywords: compliance costs, SAF-T accounting, SME, Portugal

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4940 Optimization of Process Parameters using Response Surface Methodology for the Removal of Zinc(II) by Solvent Extraction

Authors: B. Guezzen, M.A. Didi, B. Medjahed

Abstract:

A factorial design of experiments and a response surface methodology were implemented to investigate the liquid-liquid extraction process of zinc (II) from acetate medium using the 1-Butyl-imidazolium di(2-ethylhexyl) phosphate [BIm+][D2EHP-]. The optimization process of extraction parameters such as the initial pH effect (2.5, 4.5, and 6.6), ionic liquid concentration (1, 5.5, and 10 mM) and salt effect (0.01, 5, and 10 mM) was carried out using a three-level full factorial design (33). The results of the factorial design demonstrate that all these factors are statistically significant, including the square effects of pH and ionic liquid concentration. The results showed that the order of significance: IL concentration > salt effect > initial pH. Analysis of variance (ANOVA) showing high coefficient of determination (R2 = 0.91) and low probability values (P < 0.05) signifies the validity of the predicted second-order quadratic model for Zn (II) extraction. The optimum conditions for the extraction of zinc (II) at the constant temperature (20 °C), initial Zn (II) concentration (1mM) and A/O ratio of unity were: initial pH (4.8), extractant concentration (9.9 mM), and NaCl concentration (8.2 mM). At the optimized condition, the metal ion could be quantitatively extracted.

Keywords: ionic liquid, response surface methodology, solvent extraction, zinc acetate

Procedia PDF Downloads 344
4939 Impact of Electric Vehicles on Energy Consumption and Environment

Authors: Amela Ajanovic, Reinhard Haas

Abstract:

Electric vehicles (EVs) are considered as an important means to cope with current environmental problems in transport. However, their high capital costs and limited driving ranges state major barriers to a broader market penetration. The core objective of this paper is to investigate the future market prospects of various types of EVs from an economic and ecological point of view. Our method of approach is based on the calculation of total cost of ownership of EVs in comparison to conventional cars and a life-cycle approach to assess the environmental benignity. The most crucial parameters in this context are km driven per year, depreciation time of the car and interest rate. The analysis of future prospects it is based on technological learning regarding investment costs of batteries. The major results are the major disadvantages of battery electric vehicles (BEVs) are the high capital costs, mainly due to the battery, and a low driving range in comparison to conventional vehicles. These problems could be reduced with plug-in hybrids (PHEV) and range extenders (REXs). However, these technologies have lower CO₂ emissions in the whole energy supply chain than conventional vehicles, but unlike BEV they are not zero-emission vehicles at the point of use. The number of km driven has a higher impact on total mobility costs than the learning rate. Hence, the use of EVs as taxis and in car-sharing leads to the best economic performance. The most popular EVs are currently full hybrid EVs. They have only slightly higher costs and similar operating ranges as conventional vehicles. But since they are dependent on fossil fuels, they can only be seen as energy efficiency measure. However, they can serve as a bridging technology, as long as BEVs and fuel cell vehicle do not gain high popularity, and together with PHEVs and REX contribute to faster technological learning and reduction in battery costs. Regarding the promotion of EVs, the best results could be reached with a combination of monetary and non-monetary incentives, as in Norway for example. The major conclusion is that to harvest the full environmental benefits of EVs a very important aspect is the introduction of CO₂-based fuel taxes. This should ensure that the electricity for EVs is generated from renewable energy sources; otherwise, total CO₂ emissions are likely higher than those of conventional cars.

Keywords: costs, mobility, policy, sustainability,

Procedia PDF Downloads 199
4938 Impact Position Method Based on Distributed Structure Multi-Agent Coordination with JADE

Authors: YU Kaijun, Liang Dong, Zhang Yarong, Jin Zhenzhou, Yang Zhaobao

Abstract:

For the impact monitoring of distributed structures, the traditional positioning methods are based on the time difference, which includes the four-point arc positioning method and the triangulation positioning method. But in the actual operation, these two methods have errors. In this paper, the Multi-Agent Blackboard Coordination Principle is used to combine the two methods. Fusion steps: (1) The four-point arc locating agent calculates the initial point and records it to the Blackboard Module.(2) The triangulation agent gets its initial parameters by accessing the initial point.(3) The triangulation agent constantly accesses the blackboard module to update its initial parameters, and it also logs its calculated point into the blackboard.(4) When the subsequent calculation point and the initial calculation point are within the allowable error, the whole coordination fusion process is finished. This paper presents a Multi-Agent collaboration method whose agent framework is JADE. The JADE platform consists of several agent containers, with the agent running in each container. Because of the perfect management and debugging tools of the JADE, it is very convenient to deal with complex data in a large structure. Finally, based on the data in Jade, the results show that the impact location method based on Multi-Agent coordination fusion can reduce the error of the two methods.

Keywords: impact monitoring, structural health monitoring(SHM), multi-agent system(MAS), black-board coordination, JADE

Procedia PDF Downloads 148
4937 Recent Developments and Expectations in the Legal Expenses Insurance in Turkey

Authors: İbrahim Arslan, Mücahit Ünal

Abstract:

An important issue to ensure justice is to simplify the right to seek justice. But there is a cost of seeking justice in civil law. It costs at least, attorneys' fees and judicial expenses during the beginning and in case of losing a trial. Indeed, most of the people refrain from seeking justice because of these expenses. Therefore, it is not inappropriate to say that the removal of obstacles staying on the way of seeking justice will increase the belief in justice. Legal expenses insurance is a private law contract of insurance in which the insurer is obliged to pay premiums of the insured, to provide the necessary services for the protection of legal interests of the insured person within the agreed scope. This type of insurance is being practiced in the Western world for a long time. The special rights, duties and obligations of the parties to a legal expenses insurance contract shall be governed by the Turkish Commercial Code (TCC) and the contractual agreements which are regularly closed in the form of general terms and conditions. If the number of the legal expenses insurance contracts concluded increase this will definitely improve the percentage of seeking justice before the courts. The general terms and conditions applicable in Turkey generally include litigation costs, referee fees, guarantee fund , enforcement costs , appeal costs borne decision corrections costs. In addition, besides the insured, other family members or the people specified in the policy are protected in the scope of personal/family legal expenses insurance. The commercial law disputes fall outside the scope of coverage in this insurance branch. The insured person chooses his own lawyer and the insurer is not allowed to give advice during the selection of a lawyer. In April 2015, the Prime Minister announced of a new era in the field of legal expenses insurance in Turkey and this announcement excited the insurance industry and legal community.

Keywords: insurance, in the Turkish law on legal protection insurance, legal protection insurance, legal protection

Procedia PDF Downloads 331
4936 A Paradigm Shift in the Cost of Illness of Type 2 Diabetes Mellitus over a Decade in South India: A Prevalence Based Study

Authors: Usha S. Adiga, Sachidanada Adiga

Abstract:

Introduction: Diabetes Mellitus (DM) is one of the most common non-communicable diseases which imposes a large economic burden on the global health-care system. Cost of illness studies in India have assessed the health care cost of DM, but have certain limitations due to lack of standardization of the methods used, improper documentation of data, lack of follow up, etc. The objective of the study was to estimate the cost of illness of uncomplicated versus complicated type 2 diabetes mellitus in Coastal Karnataka, India. The study also aimed to find out the trend of cost of illness of the disease over a decade. Methodology: A prevalence based bottom-up approach study was carried out in two tertiary care hospitals located in Coastal Karnataka after ethical approval. Direct Medical costs like annual laboratory costs, pharmacy cost, consultation charges, hospital bed charges, surgical /intervention costs of 238 diabetics and 340 diabetic patients respectively from two hospitals were obtained from the medical record sections. Patients were divided into six groups, uncomplicated diabetes, diabetic retinopathy(DR), nephropathy(DN), neuropathy(DNeu), diabetic foot(DF), and ischemic heart disease (IHD). Different costs incurred in 2008 and 2017 in these groups were compared, to study the trend of cost of illness. Kruskal Wallis test followed by Dunn’s test were used to compare median costs between the groups and Spearman's correlation test was used for correlation studies. Results: Uncomplicated patients had significantly lower costs (p <0.0001) compared to other groups. Patients with IHD had highest Medical expenses (p < 0.0001), followed by DN and DF (p < 0.0001 ). Annual medical costs incurred were 1.8, 2.76, 2.77, 1.76, and 4.34 times higher in retinopathy, nephropathy, diabetic foot, neuropathy and IHD patients as compared to the cost incurred in managing uncomplicated diabetics. Other costs also showed a similar pattern of rising. A positive correlation was observed between the costs incurred and duration of diabetes, a negative correlation between the glycemic status and cost incurred. The cost incurred in the management of DM in 2017 was found to be elevated 1.4 - 2.7 times when compared to that in 2008. Conclusion: It is evident from the study that the economic burden due to diabetes mellitus is substantial. It poses a significant financial burden on the healthcare system, individual and society as a whole. There is a need for the strategies to achieve optimal glycemic control and operationalize regular and early screening methods for complications so as to reduce the burden of the disease.

Keywords: COI, diabetes mellitus, a bottom up approach, economics

Procedia PDF Downloads 91
4935 Multiple-Material Flow Control in Construction Supply Chain with External Storage Site

Authors: Fatmah Almathkour

Abstract:

Managing and controlling the construction supply chain (CSC) are very important components of effective construction project execution. The goals of managing the CSC are to reduce uncertainty and optimize the performance of a construction project by improving efficiency and reducing project costs. The heart of much SC activity is addressing risk, and the CSC is no different. The delivery and consumption of construction materials is highly variable due to the complexity of construction operations, rapidly changing demand for certain components, lead time variability from suppliers, transportation time variability, and disruptions at the job site. Current notions of managing and controlling CSC, involve focusing on one project at a time with a push-based material ordering system based on the initial construction schedule and, then, holding a tremendous amount of inventory. A two-stage methodology was proposed to coordinate the feed-forward control of advanced order placement with a supplier to a feedback local control in the form of adding the ability to transship materials between projects to improve efficiency and reduce costs. It focused on the single supplier integrated production and transshipment problem with multiple products. The methodology is used as a design tool for the CSC because it includes an external storage site not associated with one of the projects. The idea is to add this feature to a highly constrained environment to explore its effectiveness in buffering the impact of variability and maintaining project schedule at low cost. The methodology uses deterministic optimization models with objectives that minimizing the total cost of the CSC. To illustrate how this methodology can be used in practice and the types of information that can be gleaned, it is tested on a number of cases based on the real example of multiple construction projects in Kuwait.

Keywords: construction supply chain, inventory control supply chain, transshipment

Procedia PDF Downloads 100
4934 A Digital Health Approach: Using Electronic Health Records to Evaluate the Cost Benefit of Early Diagnosis of Alpha-1 Antitrypsin Deficiency in the UK

Authors: Sneha Shankar, Orlando Buendia, Will Evans

Abstract:

Alpha-1 antitrypsin deficiency (AATD) is a rare, genetic, and multisystemic condition. Underdiagnosis is common, leading to chronic pulmonary and hepatic complications, increased resource utilization, and additional costs to the healthcare system. Currently, there is limited evidence of the direct medical costs of AATD diagnosis in the UK. This study explores the economic impact of AATD patients during the 3 years before diagnosis and to identify the major cost drivers using primary and secondary care electronic health record (EHR) data. The 3 years before diagnosis time period was chosen based on the ability of our tool to identify patients earlier. The AATD algorithm was created using published disease criteria and applied to 148 known AATD patients’ EHR found in a primary care database of 936,148 patients (413,674 Biobank and 501,188 in a single primary care locality). Among 148 patients, 9 patients were flagged earlier by the tool and, on average, could save 3 (1-6) years per patient. We analysed 101 of the 148 AATD patients’ primary care journey and 20 patients’ Hospital Episode Statistics (HES) data, all of whom had at least 3 years of clinical history in their records before diagnosis. The codes related to laboratory tests, clinical visits, referrals, hospitalization days, day case, and inpatient admissions attributable to AATD were examined in this 3-year period before diagnosis. The average cost per patient was calculated, and the direct medical costs were modelled based on the mean prevalence of 100 AATD patients in a 500,000 population. A deterministic sensitivity analysis (DSA) of 20% was performed to determine the major cost drivers. Cost data was obtained from the NHS National tariff 2020/21, National Schedule of NHS Costs 2018/19, PSSRU 2018/19, and private care tariff. The total direct medical cost of one hundred AATD patients three years before diagnosis in primary and secondary care in the UK was £3,556,489, with an average direct cost per patient of £35,565. A vast majority of this total direct cost (95%) was associated with inpatient admissions (£3,378,229). The DSA determined that the costs associated with tier-2 laboratory tests and inpatient admissions were the greatest contributors to direct costs in primary and secondary care, respectively. This retrospective study shows the role of EHRs in calculating direct medical costs and the potential benefit of new technologies for the early identification of patients with AATD to reduce the economic burden in primary and secondary care in the UK.

Keywords: alpha-1 antitrypsin deficiency, costs, digital health, early diagnosis

Procedia PDF Downloads 140
4933 Comparative Study of Affricate Initial Consonants in Chinese and Slovak

Authors: Maria Istvanova

Abstract:

The purpose of the comparative study of the affricate consonants in Chinese and Slovak is to increase the awareness of the main distinguishing features between these two languages taking into consideration this particular group of consonants. This study determines the main difficulties of the Slovak learners in the process of acquiring correct pronunciation of affricate initial consonants in Chinese based on the understanding of the distinguishing features of Chinese and Slovak affricates in combination with the experimental measuring of VOT values. The software tool Praat is used for the analysis of the recorded language samples. The language samples contain recordings of a Chinese native speaker and Slovak students of Chinese with different language proficiency levels. Based on the results of the analysis in Praat, the study identifies erroneous pronunciation and provide clarification of its cause.

Keywords: Chinese, comparative study, initial consonants, pronunciation, Slovak

Procedia PDF Downloads 124
4932 Neurophysiology of Domain Specific Execution Costs of Grasping in Working Memory Phases

Authors: Rumeysa Gunduz, Dirk Koester, Thomas Schack

Abstract:

Previous behavioral studies have shown that working memory (WM) and manual actions share limited capacity cognitive resources, which in turn results in execution costs of manual actions in WM. However, to the best of our knowledge, there is no study investigating the neurophysiology of execution costs. The current study aims to fill this research gap investigating the neurophysiology of execution costs of grasping in WM phases (encoding, maintenance, retrieval) considering verbal and visuospatial domains of WM. A WM-grasping dual task paradigm was implemented to examine execution costs. Baseline single task required performing verbal or visuospatial version of a WM task. Dual task required performing the WM task embedded in a high precision grasp to place task. 30 participants were tested in a 2 (single vs. dual task) x 2 (visuo-spatial vs. verbal WM) within subject design. Event related potentials (ERPs) were extracted for each WM phase separately in the single and dual tasks. Memory performance for visuospatial WM, but not for verbal WM, was significantly lower in the dual task compared to the single task. Encoding related ERPs in the single task revealed different ERPs of verbal WM and visuospatial WM at bilateral anterior sites and right posterior site. In the dual task, bilateral anterior difference disappeared due to bilaterally increased anterior negativities for visuospatial WM. Maintenance related ERPs in the dual task revealed different ERPs of verbal WM and visuospatial WM at bilateral posterior sites. There was also anterior negativity for visuospatial WM. Retrieval related ERPs in the single task revealed different ERPs of verbal WM and visuospatial WM at bilateral posterior sites. In the dual task, there was no difference between verbal WM and visuospatial WM. Behavioral and ERP findings suggest that execution of grasping shares cognitive resources only with visuospatial WM, which in turn results in domain specific execution costs. Moreover, ERP findings suggest unique patterns of costs in each WM phase, which supports the idea that each WM phase reflects a separate cognitive process. This study not only contributes to the understanding of cognitive principles of manual action control, but also contributes to the understanding of WM as an entity consisting of separate modalities and cognitive processes.

Keywords: dual task, grasping execution, neurophysiology, working memory domains, working memory phases

Procedia PDF Downloads 398
4931 Reducing Change-Related Costs in Assembly of Lithium-Ion Batteries for Electric Cars by Mechanical Decoupling

Authors: Achim Kampker, Heiner Hans Heimes, Mathias Ordung, Nemanja Sarovic

Abstract:

A key component of the drive train of electric vehicles is the lithium-ion battery system. Among various other components, such as the battery management system or the thermal management system, the battery system mostly consists of several cells which are integrated mechanically as well as electrically. Due to different vehicle concepts with regards to space, energy and power specifications, there is a variety of different battery systems. The corresponding assembly lines are specially designed for each battery concept. Minor changes to certain characteristics of the battery have a disproportionally high effect on the set-up effort in the form of high change-related costs. This paper will focus on battery systems which are made out of battery cells with a prismatic format. The product architecture and the assembly process will be analyzed in detail based on battery concepts of existing electric cars and key variety-causing drivers will be identified. On this basis, several measures will be presented and discussed on how to change the product architecture and the assembly process in order to reduce change-related costs.

Keywords: assembly, automotive industry, battery system, battery concept

Procedia PDF Downloads 275
4930 A Robust Optimization of Chassis Durability/Comfort Compromise Using Chebyshev Polynomial Chaos Expansion Method

Authors: Hanwei Gao, Louis Jezequel, Eric Cabrol, Bernard Vitry

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The chassis system is composed of complex elements that take up all the loads from the tire-ground contact area and thus it plays an important role in numerous specifications such as durability, comfort, crash, etc. During the development of new vehicle projects in Renault, durability validation is always the main focus while deployment of comfort comes later in the project. Therefore, sometimes design choices have to be reconsidered because of the natural incompatibility between these two specifications. Besides, robustness is also an important point of concern as it is related to manufacturing costs as well as the performance after the ageing of components like shock absorbers. In this paper an approach is proposed aiming to realize a multi-objective optimization between chassis endurance and comfort while taking the random factors into consideration. The adaptive-sparse polynomial chaos expansion method (PCE) with Chebyshev polynomial series has been applied to predict responses’ uncertainty intervals of a system according to its uncertain-but-bounded parameters. The approach can be divided into three steps. First an initial design of experiments is realized to build the response surfaces which represent statistically a black-box system. Secondly within several iterations an optimum set is proposed and validated which will form a Pareto front. At the same time the robustness of each response, served as additional objectives, is calculated from the pre-defined parameter intervals and the response surfaces obtained in the first step. Finally an inverse strategy is carried out to determine the parameters’ tolerance combination with a maximally acceptable degradation of the responses in terms of manufacturing costs. A quarter car model has been tested as an example by applying the road excitations from the actual road measurements for both endurance and comfort calculations. One indicator based on the Basquin’s law is defined to compare the global chassis durability of different parameter settings. Another indicator related to comfort is obtained from the vertical acceleration of the sprung mass. An optimum set with best robustness has been finally obtained and the reference tests prove a good robustness prediction of Chebyshev PCE method. This example demonstrates the effectiveness and reliability of the approach, in particular its ability to save computational costs for a complex system.

Keywords: chassis durability, Chebyshev polynomials, multi-objective optimization, polynomial chaos expansion, ride comfort, robust design

Procedia PDF Downloads 129
4929 Limited Ventilation Efficacy of Prehospital I-Gel Insertion in Out-of-Hospital Cardiac Arrest Patients

Authors: Eunhye Cho, Hyuk-Hoon Kim, Sieun Lee, Minjung Kathy Chae

Abstract:

Introduction: I-gel is a commonly used supraglottic advanced airway device in prehospital out-of-hospital cardiac arrest (OHCA) allowing for minimal interruption of continuous chest compression. However, previous studies have shown that prehospital supraglottic airway had inferior neurologic outcomes and survival compared to no advanced prehospital airway with conventional bag mask ventilation. We hypothesize that continuous compression with i-gel as an advanced airway may cause insufficient ventilation compared to 30:2 chest compression with conventional BVM. Therefore, we investigated the ventilation efficacy of i-gel with the initial arterial blood gas analysis in OHCA patients visiting our ER. Material and Method: Demographics, arrest parameters including i-gel insertion, initial arterial blood gas analysis was retrospectively analysed for 119 transported OHCA patients that visited our ER. Linear regression was done to investigate the association with i-gel insertion and initial pCO2 as a surrogate of prehospital ventilation. Result: A total of 52 patients were analysed for the study. Of the patients who visited the ER during OHCA, 24 patients had i-gel insertion and 28 patients had BVM as airway management in the prehospital phase. Prehospital i-gel insertion was associated with the initial pCO2 level (B coefficient 29.9, SE 10.1, p<0.01) after adjusting for bystander CPR, cardiogenic cause of arrest, EMS call to arrival. Conclusion: Despite many limitations to the study, prehospital insertion of i-gel was associated with high initial pCO2 values in OHCA patients visiting our ER, possibly indicating insufficient ventilation with prehospital i-gel as an advanced airway and continuous chest compressions.

Keywords: arrest, I-gel, prehospital, ventilation

Procedia PDF Downloads 310