Search results for: opioid consumption
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 3333

Search results for: opioid consumption

3303 Case Report: Opioid Sparing Anaesthesia with Dexmedetomidine in General Surgery

Authors: Shang Yee Chong

Abstract:

Perioperative pain is a complex mechanism activated by various nociceptive, neuropathic, and inflammatory pathways. Opioids have long been a mainstay for analgesia in this period, even as we are continuously moving towards a multimodal model to improve pain control while minimising side effects. Dexmedetomidine, a potent alpha-2 agonist, is a useful sedative and hypnotic agent. Its use in the intensive care unit has been well described, and it is increasingly an adjunct intraoperatively for its opioid sparing effects and to decrease pain scores. We describe a case of a general surgical patient in whom minimal opioids was required with dexmedetomidine use. The patient was a 61-year-old Indian gentleman with a history of hyperlipidaemia and type 2 diabetes mellitus, presenting with rectal adenocarcinoma detected on colonoscopy. He was scheduled for a robotic ultra-low anterior resection. The patient was induced with intravenous fentanyl 75mcg, propofol 160mg and atracurium 40mg. He was intubated conventionally and mechanically ventilated. Anaesthesia was maintained with inhalational desflurane and anaesthetic depth was measured with the Masimo EEG Sedline brain function monitor. An initial intravenous dexmedetomidine dose (bolus) of 1ug/kg for 10 minutes was given prior to anaesthetic induction and thereafter, an infusion of 0.2-0.4ug/kg/hr to the end of surgery. In addition, a bolus dose of intravenous lignocaine 1.5mg/kg followed by an infusion at 1mg/kg/hr throughout the surgery was administered. A total of 10mmol of magnesium sulphate and intravenous paracetamol 1000mg were also given for analgesia. There were no significant episodes of bradycardia or hypotension. A total of intravenous phenylephrine 650mcg was given throughout to maintain the patient’s mean arterial pressure within 10-15mmHg of baseline. The surgical time lasted for 5 hours and 40minutes. Postoperatively the patient was reversed and extubated successfully. He was alert and comfortable and pain scores were minimal in the immediate post op period in the postoperative recovery unit. Time to first analgesia was 4 hours postoperatively – with paracetamol 1g administered. This was given at 6 hourly intervals strictly for 5 days post surgery, along with celecoxib 200mg BD as prescribed by the surgeon regardless of pain scores. Oral oxycodone was prescribed as a rescue analgesic for pain scores > 3/10, but the patient did not require any dose. Neither was there nausea or vomiting. The patient was discharged on postoperative day 5. This case has reinforced the use of dexmedetomidine as an adjunct in general surgery cases, highlighting its excellent opioid-sparing effects. In the entire patient’s hospital stay, the only dose of opioid he received was 75mcg of fentanyl at the time of anaesthetic induction. The patient suffered no opioid adverse effects such as nausea, vomiting or postoperative ileus, and pain scores varied from 0-2/10. However, intravenous lignocaine infusion was also used in this instance, which would have helped improve pain scores. Paracetamol, lignocaine, and dexmedetomidine is thus an effective, opioid-sparing combination of multi-modal analgesia for major abdominal surgery cases.

Keywords: analgesia, dexmedetomidine, general surgery, opioid sparing

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3302 Modulation of Receptor-Activation Due to Hydrogen Bond Formation

Authors: Sourav Ray, Christoph Stein, Marcus Weber

Abstract:

A new class of drug candidates, initially derived from mathematical modeling of ligand-receptor interactions, activate the μ-opioid receptor (MOR) preferentially at acidic extracellular pH-levels, as present in injured tissues. This is of commercial interest because it may preclude the adverse effects of conventional MOR agonists like fentanyl, which include but are not limited to addiction, constipation, sedation, and apnea. Animal studies indicate the importance of taking the pH value of the chemical environment of MOR into account when designing new drugs. Hydrogen bonds (HBs) play a crucial role in stabilizing protein secondary structure and molecular interaction, such as ligand-protein interaction. These bonds may depend on the pH value of the chemical environment. For the MOR, antagonist naloxone and agonist [D-Ala2,N-Me-Phe4,Gly5-ol]-enkephalin (DAMGO) form HBs with ionizable residue HIS 297 at physiological pH to modulate signaling. However, such interactions were markedly reduced at acidic pH. Although fentanyl-induced signaling is also diminished at acidic pH, HBs with HIS 297 residue are not observed at either acidic or physiological pH for this strong agonist of the MOR. Molecular dynamics (MD) simulations can provide greater insight into the interaction between the ligand of interest and the HIS 297 residue. Amino acid protonation states are adjusted to the model difference in system acidity. Unbiased and unrestrained MD simulations were performed, with the ligand in the proximity of the HIS 297 residue. Ligand-receptor complexes were embedded in 1-palmitoyl-2-oleoyl-sn glycero-3-phosphatidylcholine (POPC) bilayer to mimic the membrane environment. The occurrence of HBs between the different ligands and the HIS 297 residue of MOR at acidic and physiological pH values were tracked across the various simulation trajectories. No HB formation was observed between fentanyl and HIS 297 residue at either acidic or physiological pH. Naloxone formed some HBs with HIS 297 at pH 5, but no such HBs were noted at pH 7. Interestingly, DAMGO displayed an opposite yet more pronounced HB formation trend compared to naloxone. Whereas a marginal number of HBs could be observed at even pH 5, HBs with HIS 297 were more stable and widely present at pH 7. The HB formation plays no and marginal role in the interaction of fentanyl and naloxone, respectively, with the HIS 297 residue of MOR. However, HBs play a significant role in the DAMGO and HIS 297 interaction. Post DAMGO administration, these HBs might be crucial for the remediation of opioid tolerance and restoration of opioid sensitivity. Although experimental studies concur with our observations regarding the influence of HB formation on the fentanyl and DAMGO interaction with HIS 297, the same could not be conclusively stated for naloxone. Therefore, some other supplementary interactions might be responsible for the modulation of the MOR activity by naloxone binding at pH 7 but not at pH 5. Further elucidation of the mechanism of naloxone action on the MOR could assist in the formulation of cost-effective naloxone-based treatment of opioid overdose or opioid-induced side effects.

Keywords: effect of system acidity, hydrogen bond formation, opioid action, receptor activation

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3301 Association of Preoperative Pain Catastrophizing with Postoperative Pain after Lower Limb Trauma Surgery

Authors: Asish Subedi, Krishna Pokharel, Birendra Prasad Sah, Pashupati Chaudhary

Abstract:

Objectives: To evaluate an association between preoperative Nepali pain catastrophizing scale (N-PCS) scores and postoperative pain intensity and total opioid consumption. Methods: In this prospective cohort study we enrolled 135 patients with an American Society of Anaesthesiologists physical status I or II, aged between 18 and 65 years, and scheduled for surgery for lower-extremity fracture under spinal anaesthesia. Maximum postoperative pain reported during the 24 h was classified into two groups, no-mild pain group (Numeric rating scale [NRS] scores 1 to 3) and a moderate-severe pain group (NRS 4-10). The Spearman correlation coefficient was used to compare the association between the baseline N-PCS scores and outcome variables, i.e., the maximum NRS pain score and the total tramadol consumption within the first 24 h after surgery. Logistic regression models were used to identify the predictors for the intensity of postoperative pain. Results: As four patients violated the protocol, the data of 131 patients were analysed. Mean N-PCS scores reported by the moderate-severe pain group was 27.39 ±9.50 compared to 18.64 ±10 mean N-PCS scores by the no-mild pain group (p<0.001). Preoperative PCS scores correlated positively with postoperative pain intensity (r =0.39, [95% CI 0.23-0.52], p<0.001) and total tramadol consumption (r =0.32, [95% CI 0.16-0.47], p<0.001). An increase in catastrophizing scores was associated with postoperative moderate-severe pain (odds ratio, 1.08 [95% confidence interval, 1.02-1.15], p=0.006) after adjusting for gender, ethnicity and preoperative anxiety. Conclusion: Patients who reported higher pain catastrophizing preoperatively were at increased risk of experiencing moderate-severe postoperative pain.

Keywords: nepali, pain catastrophizing, postoperative pain, trauma

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3300 Utilization of Informatics to Transform Clinical Data into a Simplified Reporting System to Examine the Analgesic Prescribing Practices of a Single Urban Hospital’s Emergency Department

Authors: Rubaiat S. Ahmed, Jemer Garrido, Sergey M. Motov

Abstract:

Clinical informatics (CI) enables the transformation of data into a systematic organization that improves the quality of care and the generation of positive health outcomes.Innovative technology through informatics that compiles accurate data on analgesic utilization in the emergency department can enhance pain management in this important clinical setting. We aim to establish a simplified reporting system through CI to examine and assess the analgesic prescribing practices in the EDthrough executing a U.S. federal grant project on opioid reduction initiatives. Queried data points of interest from a level-one trauma ED’s electronic medical records were used to create data sets and develop informational/visual reporting dashboards (on Microsoft Excel and Google Sheets) concerning analgesic usage across several pre-defined parameters and performance metrics using CI. The data was then qualitatively analyzed to evaluate ED analgesic prescribing trends by departmental clinicians and leadership. During a 12-month reporting period (Dec. 1, 2020 – Nov. 30, 2021) for the ongoing project, about 41% of all ED patient visits (N = 91,747) were for pain conditions, of which 81.6% received analgesics in the ED and at discharge (D/C). Of those treated with analgesics, 24.3% received opioids compared to 75.7% receiving opioid alternatives in the ED and at D/C, including non-pharmacological modalities. Demographics showed among patients receiving analgesics, 56.7% were aged between 18-64, 51.8% were male, 51.7% were white, and 66.2% had government funded health insurance. Ninety-one percent of all opioids prescribed were in the ED, with intravenous (IV) morphine, IV fentanyl, and morphine sulfate immediate release (MSIR) tablets accounting for 88.0% of ED dispensed opioids. With 9.3% of all opioids prescribed at D/C, MSIR was dispensed 72.1% of the time. Hydrocodone, oxycodone, and tramadol usage to only 10-15% of the time, and hydromorphone at 0%. Of opioid alternatives, non-steroidal anti-inflammatory drugs were utilized 60.3% of the time, 23.5% with local anesthetics and ultrasound-guided nerve blocks, and 7.9% with acetaminophen as the primary non-opioid drug categories prescribed by ED providers. Non-pharmacological analgesia included virtual reality and other modalities. An average of 18.5 ED opioid orders and 1.9 opioid D/C prescriptions per 102.4 daily ED patient visits was observed for the period. Compared to other specialties within our institution, 2.0% of opioid D/C prescriptions are given by ED providers, compared to the national average of 4.8%. Opioid alternatives accounted for 69.7% and 30.3% usage, versus 90.7% and 9.3% for opioids in the ED and D/C, respectively.There is a pressing need for concise, relevant, and reliable clinical data on analgesic utilization for ED providers and leadership to evaluate prescribing practices and make data-driven decisions. Basic computer software can be used to create effective visual reporting dashboards with indicators that convey relevant and timely information in an easy-to-digest manner. We accurately examined our ED's analgesic prescribing practices using CI through dashboard reporting. Such reporting tools can quickly identify key performance indicators and prioritize data to enhance pain management and promote safe prescribing practices in the emergency setting.

Keywords: clinical informatics, dashboards, emergency department, health informatics, healthcare informatics, medical informatics, opioids, pain management, technology

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3299 Consumption Insurance against the Chronic Illness: Evidence from Thailand

Authors: Yuthapoom Thanakijborisut

Abstract:

This paper studies consumption insurance against the chronic illness in Thailand. The study estimates the impact of household consumption in the chronic illness on consumption growth. Chronic illness is the health care costs of a person or a household’s decision in treatment for the long term; the causes and effects of the household’s ability for smooth consumption. The chronic illnesses are measured in health status when at least one member within the household faces the chronic illness. The data used is from the Household Social Economic Panel Survey conducted during 2007 and 2012. The survey collected data from approximately 6,000 households from every province, both inside and outside municipal areas in Thailand. The study estimates the change in household consumption by using an ordinary least squares (OLS) regression model. The result shows that the members within the household facing the chronic illness would reduce the consumption by around 4%. This case indicates that consumption insurance in Thailand is quite sufficient against chronic illness.

Keywords: consumption insurance, chronic illness, health care, Thailand

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3298 Mapping of Electrical Energy Consumption Yogyakarta Province in 2014-2025

Authors: Alfi Al Fahreizy

Abstract:

Yogyakarta is one of the provinces in Indonesia that often get a power outage because of high load electrical consumption. The authors mapped the electrical energy consumption [GWh] for the province of Yogyakarta in 2014-2025 using LEAP (Long-range Energy Alternatives Planning system) software. This paper use BAU (Business As Usual) scenario. BAU scenario in which the projection is based on the assumption that growth in electricity consumption will run as normally as before. The goal is to be able to see the electrical energy consumption in the household sector, industry , business, social, government office building, and street lighting. The data is the data projected statistical population and consumption data electricity [GWh] 2010, 2011, 2012 in Yogyakarta province.

Keywords: LEAP, energy consumption, Yogyakarta, BAU

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3297 Craving Intensity Measurements in Opiate Addicts to Objectify the Opioid Substitution Therapy Dose and Reduce the Relapse Risk

Authors: Igna Brajevic-Gizdic, Magda Pletikosa Pavić

Abstract:

Introduction: Research in opiate addiction is increasingly indicating the importance of substitution therapy in opiate addicts. Opiate addiction is a chronic relapsing disease that includes craving as a criterion. Craving has been considered a predictor of a relapse, which is defined as a strong desire with an excessive need to take a substance. The study aimed to measure the intensity of craving using the VAS (visual analog scale) in opioid addicts taking Opioid Substitution Therapy (OST). Method: The total sample compromised of 30 participants in outpatient treatment. Two groups of opiate addicts were considered: Methadone-maintenance and buprenorphine-maintenance addicts. The participants completed the survey questionnaire during the outpatient treatment. Results: The results indicated high levels of cravings in patients during the treatment of OST, which is considered an important destabilization factor in abstinence. Thus, the use of methadone/buprenorphine dose should be considered. Conclusion: These findings provided an objective measurement of methadone /buprenorphine dosage and therapy options. The underdoes of OST can put patients at high risk of relapse, resulting in high levels of craving. Thus, when determining the therapeutic dose of OST, it is crucial to consider patients' cravings. This would achieve stabilization more quickly and avoid relapse in abstinence. Subjective physician assessment and patients' statement are the main criteria to determine OST dosage. Future studies should use larger sample sizes and focus on the importance of intensity craving measurement on OST to objectify methadone /buprenorphine dosage.

Keywords: buprenorphine, craving, heroin addicts, methadone, OST

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3296 Energy Consumption Forecast Procedure for an Industrial Facility

Authors: Tatyana Aleksandrovna Barbasova, Lev Sergeevich Kazarinov, Olga Valerevna Kolesnikova, Aleksandra Aleksandrovna Filimonova

Abstract:

We regard forecasting of energy consumption by private production areas of a large industrial facility as well as by the facility itself. As for production areas the forecast is made based on empirical dependencies of the specific energy consumption and the production output. As for the facility itself implementation of the task to minimize the energy consumption forecasting error is based on adjustment of the facility’s actual energy consumption values evaluated with the metering device and the total design energy consumption of separate production areas of the facility. The suggested procedure of optimal energy consumption was tested based on the actual data of core product output and energy consumption by a group of workshops and power plants of the large iron and steel facility. Test results show that implementation of this procedure gives the mean accuracy of energy consumption forecasting for winter 2014 of 0.11% for the group of workshops and 0.137% for the power plants.

Keywords: energy consumption, energy consumption forecasting error, energy efficiency, forecasting accuracy, forecasting

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3295 The Relationship between Value-Added and Energy Consumption in Iran’s Industry Sector

Authors: Morteza Raei Dehaghi, Mojtaba Molaahmadi, Seyed Mohammad Mirhashemi

Abstract:

This study aimed to explore the relationship between energy consumption and value-added in Iran’s industry sector during the time period 1973-2011. Annual data related to energy consumption and value added in the industry sector were used. The results of the study revealed a positive relationship between energy consumption and value-added of the industry sector. Similarly, the results showed that there is one-way causality between energy consumption and value-added in the industry sector.

Keywords: economic growth, energy consumption, granger causality test, industry sector

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3294 Reduced Power Consumption by Randomization for DSI3

Authors: David Levy

Abstract:

The newly released Distributed System Interface 3 (DSI3) Bus Standard specification defines 3 modulation levels from which 16 valid symbols are coded. This structure creates power consumption variations depending on the transmitted data of a factor of more than 2 between minimum and maximum. The power generation unit has to consider therefore the worst case maximum consumption all the time and be built accordingly. This paper proposes a method to reduce both the average current consumption and worst case current consumption. The transmitter randomizes the data using several pseudo-random sequences. It then estimates the energy consumption of the generated frames and selects to transmit the one which consumes the least. The transmitter also prepends the index of the pseudo-random sequence, which is not randomized, to allow the receiver to recover the original data using the correct sequence. We show that in the case that the frame occupies most of the DSI3 synchronization period, we achieve average power consumption reduction by up to 13% and the worst case power consumption is reduced by 17.7%.

Keywords: DSI3, energy, power consumption, randomization

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3293 The Use of Regional Blocks Versus IV Opioid Analgesics for Acute Traumatic Pain Management in the Emergency Department

Authors: Lajeesh Jabbar, Shibu T. Varghese

Abstract:

Being under pain is a very distressing factor that it prolongs the healing of any kind of trauma and add to the post traumatic stressful state. Alleviating the pain from acute traumatic conditions like fracture, degloving injury etc will help in faster recovery and also decrease the incidence of post traumatic stress disorder. Most of the emergency departments in INDIA are using IV opioid analgesics to relieve the patient from pain in cases of acute traumatic injuries. None of the Emergency Departments practice regional blocks in the country. In this study, we are comparing the efficacy of Regional Blocks in relieving the pain in lower limb fractures versus the use of IV analgesics for the same in the emergency department. The site of study is Malabar Institute Of Medical Sciences in Calicut in Kerala in India and is a place which receives approximately 10-20 traumatic fracture cases per day. The fracture sites used for the study purpose are femur fracture and phalangeal fractures.

Keywords: regional blocks, IV analgesia, acute traumatic pain, femur fractures, phalanx fractures

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3292 Research on Online Consumption of College Students in China with Stimulate-Organism-Reaction Driven Model

Authors: Wei Lu

Abstract:

With the development of information technology in China, network consumption is becoming more and more popular. As a special group, college students have a high degree of education and distinct opinions and personalities. In the future, the key groups of network consumption have gradually become the focus groups of network consumption. Studying college students’ online consumption behavior has important theoretical significance and practical value. Based on the Stimulus-Organism-Response (SOR) driving model and the structural equation model, this paper establishes the influencing factors model of College students’ online consumption behavior, evaluates and amends the model by using SPSS and AMOS software, analyses and determines the positive factors of marketing college students’ consumption, and provides an effective basis for guiding and promoting college student consumption.

Keywords: college students, online consumption, stimulate-organism-reaction driving model, structural equation model

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3291 Water Demand Modelling Using Artificial Neural Network in Ramallah

Authors: F. Massri, M. Shkarneh, B. Almassri

Abstract:

Water scarcity and increasing water demand especially for residential use are major challenges facing Palestine. The need to accurately forecast water consumption is useful for the planning and management of this natural resource. The main objective of this paper is to (i) study the major factors influencing the water consumption in Palestine, (ii) understand the general pattern of Household water consumption, (iii) assess the possible changes in household water consumption and suggest appropriate remedies and (iv) develop prediction model based on the Artificial Neural Network to the water consumption in Palestinian cities. The paper is organized in four parts. The first part includes literature review of household water consumption studies. The second part concerns data collection methodology, conceptual frame work for the household water consumption surveys, survey descriptions and data processing methods. The third part presents descriptive statistics, multiple regression and analysis of the water consumption in the two Palestinian cities. The final part develops the use of Artificial Neural Network for modeling the water consumption in Palestinian cities.

Keywords: water management, demand forecasting, consumption, ANN, Ramallah

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3290 The Influence of Gender and Harmful Alcohol Consumption on Academic Performance in Spanish University Students

Authors: M. S. Rodríguez, F. Cadaveira, M. F. Páramo

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First year university students comprise one of the groups most likely to indulge in hazardous alcohol consumption. The transition from secondary school to university presents a range of academic, social and developmental challenges requiring new responses that will meet the demands of this highly competitive environment. The main purpose of this research was to analyze the influence of gender and hazardous alcohol consumption on academic performance of 300 university students in Spain in a three-year follow-up study. Alcohol consumption was measured using the Alcohol Use Identification Test (AUDIT), and the average university grades were provided by the Academic Management Services of the University. Analysis of variance showed that the level of alcohol consumption significantly affected academic performance. Students undertaking hazardous alcohol consumption obtained the lowest grades during the first three years at university. These effects were particularly marked in the sample of women with a hazardous pattern of alcohol consumption, although the interaction between gender and this type of consumption was not significant. The study highlights the impact of hazardous alcohol consumption on the academic trajectory of university students. The findings confirm that alcohol consumption predicts poor academic performance in first year students and that the low level of performance is maintained throughout the university career.

Keywords: academic performance, alcohol consumption, gender, university students

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3289 Centralized Peak Consumption Smoothing Revisited for Habitat Energy Scheduling

Authors: M. Benbouzid, Q. Bresson, A. Duclos, K. Longo, Q. Morel

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Currently, electricity suppliers must predict the consumption of their customers in order to deduce the power they need to produce. It is, then, important in a first step to optimize household consumption to obtain more constant curves by limiting peaks in energy consumption. Here centralized real time scheduling is proposed to manage the equipment's starting in parallel. The aim is not to exceed a certain limit while optimizing the power consumption across a habitat. The Raspberry Pi is used as a box; this scheduler interacts with the various sensors in 6LoWPAN. At the scale of a single dwelling, household consumption decreases, particularly at times corresponding to the peaks. However, it would be wiser to consider the use of a residential complex so that the result would be more significant. So, the ceiling would no longer be fixed. The scheduling would be done on two scales, firstly, per dwelling, and secondly, at the level of a residential complex.

Keywords: smart grid, energy box, scheduling, Gang Model, energy consumption, energy management system, wireless sensor network

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3288 The Gap of Green Consumption Behavior: Driving from Attitude to Behavior

Authors: Yu Du, Jian-Guo Wang

Abstract:

Green consumption is a key link to develop the ecological economy, and consumers are vital to carry out green consumption. With environmental awareness gradually being aroused, consumers often fail to turn their positive attitude into actual green consumption behavior. According to behavior reasoning theory, reasons for adoption have a direct (positive) influence on consumers’ attitude while reasons against adoption have a direct (negative) influence on consumers’ adoption intentions, the incongruous coexistence of which leads to the attitude-behavior gap of green consumption. Based on behavior reasoning theory, this research integrates reasons for adoption and reasons against adoption into a proposed model, in which reasons both for and against green consumption mediate the relationship between consumer’ values, attitudes, and behavioral intentions. It not only extends the conventional theory of reasoned action but also provides a reference for the government and enterprises to design the repairing strategy of green consumption attitude-behavior gap.

Keywords: green product, attitude-behavior gap, behavior reasoning theory, green consumption, SEM

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3287 Comparison of Effectiveness When Ketamine was Used as an Adjuvant in Intravenous Patient-Controlled Analgesia Used to Control Cancer Pain

Authors: Donghee Kang

Abstract:

Background: Cancer pain is very difficult to control as the mechanism of pain is varied, and the patient has several co-morbidities. The use of Intravenous Patient-Controlled Analgesia (IV-PCA) can effectively control underlying pain and breakthrough pain. Ketamine is used in many pain patients due to its unique analgesic effect. In this study, it was checked whether there was a difference in the amount of analgesic usage, pain control degree, and side effects between patients who controlled pain with fentanyl-based IV-PCA and those who added Ketamine for pain control. Methods: Among the patients referred to this department for cancer pain, IV-PCA was applied to patients who were taking sufficient oral analgesics but could not control them or had blood clotting disorders that made the procedure difficult, and this patient group was targeted. In IV-PCA, 3000 mcg of Fentanyl, 160 mg of Nefopam, and 0.3 mg of Ramosetrone were mixed with normal saline to make a total volume of 100 ml. Group F used this IV-PCA as it is, and group K mixed 250 mg of Ketamine with normal saline to make a total volume of 100 ml. For IV-PCA, the basal rate was 0.5ml/h, the bolus was set to 1ml when pressed once, and the lockout time was set to 15 minutes. If pain was not controlled after IV-PCA application, 500 mcg of Fentanyl was added, and if excessive sedation or breathing difficulties occurred, the use was stopped for one hour. After that, the degree of daily pain control, analgesic usage, and side effects were investigated for seven days using this IV-PCA. Results: There was no difference between the two groups in the demographic data. Both groups had adequate pain control. Initial morphine milligram equivalents did not differ between the two groups, but the total amount of Fentanyl used for seven days was significantly different between the two groups [p=0.014], and group F used more Fentanyl through IV-PCA. In addition, the amount of sleeping pills used during the seven days was higher in Group F [p<0.01]. Overall, there was no difference in the frequency of side effects between the two groups, but the nausea was more frequent in Group F [p=0.031]. Discussion: When the two groups were compared, pain control was good in both groups. This seems to be because Fentanyl-based IV-PCA showed an adequate pain control effect. However, there was a significant difference in the total amount of opioid (Fentanyl) used, which is thought to be the opioid-sparing effect of Ketamine. Also, among the side effects, nausea was significantly less, which is thought to be possible because the amount of opioids used in the Ketamine group was small. The frequency of requesting sleeping pills was significantly less in the group using Ketamine, and it seems that Ketamine also helped improve sleep quality. In conclusion, using Ketamine with an opioid to control pain seems to have advantages. IV-PCA, which can be used effectively when other procedures are difficult, is more effective and safer when used together with Ketamine than opioids alone.

Keywords: cancer pain, intravenous patient-controlled analgesia, Ketamine, opioid

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3286 Mathematical Modelling for Diesel Consumption of Articulated Vehicle Used in Oyo State, Nigeria

Authors: Ganiyu Samson Okunlola, Ladanu Abiodun Ajala, Olaide Oluwaseun Adegbayo

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Since the usefulness of articulated vehicles is becoming more apparent and the diesel consumption of these vehicles constitutes a major portion of operating costs, development of mathematical model for their diesel consumption is of a great importance. Therefore, the present work developed a quantitative relationship between diesel consumption and vehicle age, annual use and cost of maintenance of the different makes of articulated vehicles. The vehicles selected for the study were FIAT 682 T3, IVECO 19036 and M.A.N. Diesel 19.240. The operating parameters for 90 vehicles of different age groups were recorded. Multiple regression models for diesel consumption of articulated vehicles of different makes were developed. From the analysis of results, it can be concluded that as the age of the vehicles increases, the diesel consumption increases. Also, as the diesel consumption increases, the cost of maintenance increases and there is a subsequent decrease in annual use. Moreover, FIAT 682 T3 and IVECO 19036 should be replaced at 7 years of age while M.A.N diesel should be replaced at 8 years of age. These are the ages where the diesel consumption becomes abnormal and uneconomical and they are points of optimal overhaul.

Keywords: vehicle, overhaul, age, uneconomical, diesel, consumption

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3285 Electricity Consumption and Economic Growth: The Case of Mexico

Authors: Mario Gómez, José Carlos Rodríguez

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The causal relationship between energy consumption and economic growth has been an important issue in the economic literature. This paper studies the causal relationship between electricity consumption and economic growth in Mexico for the period of 1971-2011. In so doing, unit root tests and causality test are applied. The results show that the series are stationary in levels and that there is causality running from economic growth to energy consumption. The energy conservation policies have little or no impact on economic growth in México.

Keywords: causality, economic growth, energy consumption, Mexico

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3284 The New Consumption of Sustainability for Green Capitalism

Authors: Ica Wulansari

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Today, globalization encourages the global culture acceleration in the middle of accelerated industrialization that leads to the transformation of consumption pattern. Consumption is not only considered as a need but also lifestyle, moreover, plays a role as an ideology supported by global shopping system. This paper is aimed at analyzing how global society directed to support sustainability consumption, this is line with Sustainable Development Goals (SDGs) that prioritise sustainable program for environmental preservation to cope with economic growth impact. The paper applies qualitative method to analyze through literature studies. As a result, we attempt to discuss the relationship of various concepts among globalization, consumption, and risk society that produce green capitalism. There are three points related with green capitalism: Sustainable agenda, political ecology, and sustainable commodities that show sustainable consumption pattern supported by Capitalism. Sustainability consumption system is an ideal instrument to be implemented, nevertheless, this is not only solely a modernity of ecology politics to hidden Capitalist`s interest.

Keywords: consumption, sustainability, capitalist, environmental

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3283 Environmental Sustainability and Energy Consumption: The Role of Financial Development in OPEC-1 Countries

Authors: Isah Wada

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The current research investigates the role of financial development in an environmental sustainability-energy consumption nexus for OPEC-1 member countries. The empirical findings suggest that financial development increases environmental sustainability but energy consumption and real output expansion diminishes environmental sustainability, generally. Thus, whilst real output and financial development accelerates energy consumption, environmental sustainability quality diminishes clean energy initiatives. Even more so, energy consumption and financial development stimulates real output growth. The result empirically demonstrates that policy advocates must address broader issues relating to financial development whilst seeking to achieve environmental sustainability due largely to energy consumption.

Keywords: energy consumption, environmental sustainability, financial development, OPEC, real output

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3282 Consumption Culture of Rural Youth: A Study of the Conspicuous Consumption Pattern of a Youth Sample in an Egyptian Village

Authors: Marwa H. Salah

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Modern consumption culture represents a widespread phenomenon that affects young people, as it affects all age groups in both urban and rural societies. It has been helped by globalization, specifically cultural globalization, also internal and external migration, and the immense development in information technology as well, these factors have led to the appearance of the conspicuous consumption pattern among young people. This research firstly interested in identifying the nature of this pattern of consumption among young people in the countryside, which represents a society with a special nature, was characterized by the pattern of traditional consumption. Secondly to find out whether the rural character has an impact on the conspicuous consumption of youth. Finally to identify the reasons for the rural youth's tendency to such type of consumption and if it contributes in satisfying certain social needs. The research used the anthropological method. Observation and open-ended interviews were used as tools to collect data and an interview guide was applied on a selective youth sample (40:20 male and 20 female) aged between 17to 34 in an Egyptian village located in Dakahlia governorate. The research showed that rural youth has impacted with the modern consumption culture and not isolated from it despite the lack of financial abilities. The conspicuous consumption is a dominant pattern of consumption among the Egyptian rural youth and it has been practicing by rural youth regardless of their educational & financial levels. Also, the wish to show the social and economic status, bragging and show off is the main reason for the rural youth to adopt the conspicuous consumption, moreover to face the inferior view from their counterparts’ urban youth.

Keywords: consumption culture, youth, conspicuous consumption, rural society

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3281 Investigating of the Fuel Consumption in Construction Machinery and Ways to Reduce Fuel Consumption

Authors: Reza Bahboodian

Abstract:

One of the most important factors in the use of construction machinery is the fuel consumption cost of this equipment. The use of diesel engines in off-road vehicles is an important source of nitrogen oxides and particulate matter. Emissions of nitrogen oxides and particulate matter 10 in off-road vehicles (construction and mining) may be high. Due to the high cost of fuel, it is necessary to minimize fuel consumption. Factors affecting the fuel consumption of these cars are very diverse. Climate changes such as changes in pressure, temperature, humidity, fuel type selection, type of gearbox used in the car are effective in fuel consumption and pollution, and engine efficiency. In this paper, methods for reducing fuel consumption and pollutants by considering valid European and European standards are examined based on new methods such as hybridization, optimal gear change, adding hydrogen to diesel fuel, determining optimal working fluids, and using oxidation catalysts.

Keywords: improve fuel consumption, construction machinery, pollutant reduction, determining the optimal working cycle

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3280 Granger Causal Nexus between Financial Development and Energy Consumption: Evidence from Cross Country Panel Data

Authors: Rudra P. Pradhan

Abstract:

This paper examines the Granger causal nexus between financial development and energy consumption in the group of 35 Financial Action Task Force (FATF) Countries over the period 1988-2012. The study uses two financial development indicators such as private sector credit and stock market capitalization and seven energy consumption indicators such as coal, oil, gas, electricity, hydro-electrical, nuclear and biomass. Using panel cointegration tests, the study finds that financial development and energy consumption are cointegrated, indicating the presence of a long-run relationship between the two. Using a panel vector error correction model (VECM), the study detects both bidirectional and unidirectional causality between financial development and energy consumption. The variation of this causality is due to the use of different proxies for both financial development and energy consumption. The policy implication of this study is that economic policies should recognize the differences in the financial development-energy consumption nexus in order to maintain sustainable development in the selected 35 FATF countries.

Keywords: energy consumption, financial development, FATF countries, Panel VECM

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3279 Biomimetic Building Envelopes to Reduce Energy Consumption in Hot and Dry Climates

Authors: Aswitha Bachala

Abstract:

Energy shortage became a worldwide major problem since the 1970s, due to high energy consumption. Buildings are the primary energy users which consume 40% of global energy consumption, in which, 40%-50% of building’s energy usage is consumed due to its envelope. In hot and dry climates, 40% of energy is consumed only for cooling purpose, which implies major portion of energy savings can be worked through the envelopes. Biomimicry can be one solution for extracting efficient thermoregulation strategies found in nature. This paper aims to identify different biomimetic building envelopes which shall offer a higher potential to reduce energy consumption in hot and dry climates. It focuses on investigating the scope for reducing energy consumption through biomimetic approach in terms of envelopes. An in-depth research on different biomimetic building envelopes will be presented and analyzed in terms of heat absorption, in addition to, the impact it had on reducing the buildings energy consumption. This helps to understand feasible biomimetic building envelopes to mitigate heat absorption in hot and dry climates.

Keywords: biomimicry, building envelopes, energy consumption, hot and dry climate

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3278 A Phenomenological Exploration of Alcohol Consumption Patterns and Problems Among Male Students at the University of Kwazulu-Natal

Authors: Isaiah Phillip Smith

Abstract:

It is reported that alcohol consumption accounts for 3 million annual deaths globally, thus, it is a significant public health challenge internationally. The excessive consumption of alcohol is argued in literature to be related to problematic behaviors like crime, accident, fighting, violence, and unprotected sex, among others. Alcohol consumption among university students in South Africa particularly is considered endemic – with a prevalence rate of 25.27%, 32.34%, and 23.34% across universities, colleges, and high schools. Adopting the tenets of social learning and ecological theories, the culture of drinking amongst male university students is critically explored. This study found that age, gender, early exposure to alcohol, and peer pressure are significant factors contributing to alcohol consumption amongst university students. While participants acknowledged that moderate and responsible consumption of alcohol is necessary, they agree that it does not translate to responsible drinking behaviours.

Keywords: alcohol, drinking, university, students

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3277 Analgesic Efficacy of IPACK Block in Primary Total Knee Arthroplasty (90 CASES)

Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

Abstract:

 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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3276 Government Final Consumption Expenditure and Household Consumption Expenditure NPISHS in Nigeria

Authors: Usman A. Usman

Abstract:

Undeniably, unlike the Classical side, the Keynesian perspective of the aggregate demand side indeed has a significant position in the policy, growth, and welfare of Nigeria due to government involvement and ineffective demand of the population living with poor per capita income. This study seeks to investigate the effect of Government Final Consumption Expenditure, Financial Deepening on Households, and NPISHs Final consumption expenditure using data on Nigeria from 1981 to 2019. This study employed the ADF stationarity test, Johansen Cointegration test, and Vector Error Correction Model. The results of the study revealed that the coefficient of Government final consumption expenditure has a positive effect on household consumption expenditure in the long run. There is a long-run and short-run relationship between gross fixed capital formation and household consumption expenditure. The coefficients cpsgdp (financial deepening and gross fixed capital formation posit a negative impact on household final consumption expenditure. The coefficients money supply lm2gdp, which is another proxy for financial deepening, and the coefficient FDI have a positive effect on household final consumption expenditure in the long run. Therefore, this study recommends that Gross fixed capital formation stimulates household consumption expenditure; a legal framework to support investment is a panacea to increasing hoodmold income and consumption and reducing poverty in Nigeria. Therefore, this should be a key central component of policy.

Keywords: government final consumption expenditure, household consumption expenditure, vector error correction model, cointegration

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3275 The Fall of Cultural Consumption in Spain during the Economic Crisis of 2008: Lessons for the Upcoming Crisis

Authors: Pau Rausell-Koster, Jordi Sanjuan-Belda

Abstract:

The economic crisis of 2008 had a special impact on cultural consumption in Spain. It fell by almost 30% in a few years, and its share of total family spending decreased from 3.19% in 2007 to 2.38% in 2015. In 2017, unlike other indicators, cultural consumption levels were still far from recovering their pre-crisis values. In times of economic difficulties, the satisfaction of primary subsistence needs takes priority over that of social, cultural and experiential needs, among which cultural consumption would mostly be framed. However, its evolution cannot be attributed exclusively to macroeconomic trends. In parallel to these, technological advances mainly related to the Internet have been disseminated in recent years, which have a very marked impact on the consumption patterns of some cultural sectors. Thus, the aim of this study is to define the causes of the decline in cultural consumption in Spain in recent years, and analyse what type of products, territories and population profiles suffered it especially. From the data analysis of the Family Budget Survey, the study seeks to improve the understanding of the determinants of cultural consumption and their behaviour in the face of macroeconomic trends, as well as identify and extract some policy implications regarding to the upcoming crisis caused by COVID-19.

Keywords: consume patterns, cultural consumption, economic crisis, economic trends

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3274 Treating Complex Pain and Addictions with Bioelectrode Therapy: An Acupuncture Point Stimulus Method for Relieving Human Suffering

Authors: Les Moncrieff

Abstract:

In a world awash with potent opioids flaming an international crisis, the need to explore safe alternatives has never been more urgent. Bio-electrode Therapy is a novel adjunctive treatment method for relieving acute opioid withdrawal symptoms and many types of complex acute and chronic pain (often the underlying cause of opioid dependence). By combining the science of developmental bioelectricity with Traditional Chinese Medicine’s theory of meridians, rapid relief from pain is routinely being achieved in the clinical setting. Human body functions are dependent on electrical factors, and acupuncture points on the body are known to have higher electrical conductivity than surrounding skin tissue. When tiny gold- and silver-plated electrodes are secured to the skin at specific acupuncture points using established Chinese Medicine principles and protocols, an enhanced microcurrent and electrical field are created between the electrodes, influencing the entire meridian and connecting meridians. No external power source or electrical devices are required. Endogenous DC electric fields are an essential fundamental component for development, regeneration, and wound healing. Disruptions in the normal ion-charge in the meridians and circulation of blood will manifest as pain and development of disease. With the application of these simple electrodes (gold acting as cathode and silver as anode) according to protocols, the resulting microcurrent is directed along the selected meridians to target injured or diseased organs and tissues. When injured or diseased cells have been stimulated by the microcurrent and electrical fields, the permeability of the cell membrane is affected, resulting in an immediate relief of pain, a rapid balancing of positive and negative ions (sodium, potassium, etc.) in the cells, the restoration of intracellular fluid levels, replenishment of electrolyte levels, pH balance, removal of toxins, and a re-establishment of homeostasis.

Keywords: bioelectricity, electrodes, electrical fields, acupuncture meridians, complex pain, opioid withdrawal management

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