Search results for: significant

Authors: Yusra Pintaningrum, Ilma Fahira Basyir, Sony Hilal Wicaksono, Vito A. Damay

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Background: Coronary artery calcium (CAC) scores play an important role in improving prognostic accuracy and can be selectively used to guide the allocation of statin therapy for atherosclerotic cardiovascular disease outcomes and potentially associated with the occurrence of MACE (Major Adverse Cardiovascular Event) and MI (Myocardial Infarction). Objective: This systematic review and meta-analysis aim to analyze the findings of a study about CAC Score and statin treatment effect on MI and MACE risk. Methods: Search for published scientific articles using the PRISMA (Preferred Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on PubMed, Cochrane Library, and Medline databases published in the last 20 years on “coronary artery calcium” AND “statin” AND “cardiovascular disease” Further systematic review and meta-analysis using RevMan version 5.4 were performed based on the included published scientific articles. Results: Based on 11 studies included with a total of 1055 participants, we performed a meta-analysis and found that individuals with CAC score > 0 increased risk ratio of MI 8.48 (RR = 9.48: 95% CI: 6.22 – 14.45) times and MACE 2.48 (RR = 3.48: 95% CI: 2.98 – 4.05) times higher than CAC score 0 individual. Statin compared against non-statin treatment showed a statistically insignificant overall effect on the risk of MI (P = 0.81) and MACE (P = 0.89) in an individual with elevated CAC score 1 – 100 (P = 0.65) and > 100 (P = 0.11). Conclusions: This study found that an elevated CAC scores individual has a higher risk of MI and MACE than a non-elevated CAC score individual. There is no significant effect of statin compared against non-statin treatment to reduce MI and MACE in elevated CAC score individuals of 1 – 100 or > 100.

Keywords: coronary artery calcium, statin, cardiovascular disease, myocardial infarction, MACE

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Authors: Djehich Mohamed Yousri

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As a result of the destruction and devastation left by the two world wars, the international community worked to establish a global organization based on a contractual basis, in which the Security Council was entrusted with the task of working to maintain international peace and security, and to achieve this, the United Nations Charter assigned the latter a wide authority to adapt everything It would threaten international peace and security, although the examiner of the Charter of the United Nations does not find the slightest definition of the concept of international peace and security, although these two principles are among the basic principles that the Charter stipulated the necessity of achieving, and perhaps this was also what was in the opposite case for them. And by that, we mean cases of a threat to peace, a breach of it, or an act of aggression. These terms were not dealt with in the Charter in explanation and detail, leaving ample room for the Security Council to assess each of these cases separately, and perhaps this is due to the fact that the framers of the Charter intended to set a flexible standard. It does not restrict the authority of the Security Council to carry out the adjustment process on the one hand and, on the other hand, to allow and enable the Security Council to keep pace with new developments and threats to which international peace and security are exposed. There is no doubt that the concept of international peace and security has undergone significant changes during the 70-year period that followed the establishment of the international organization. After the threat to peace and security focused - in the first stage - on cases of war or the threat of war, what distinguishes the post- The new world order is the emergence of other challenges and threats that find their source in economic, social, humanitarian, and environmental instability. Perhaps this is what the member states of the Security Council indicated during the preparation of the Peace Agenda. The expansion of the concept of peace and security is what paved the way for some permanent states to use the Security Council to legitimize and implement their decisions and take the council as a tool to implement their foreign policy and punish states instead of maintaining international peace and security, which prompted some states and jurisprudence to call for the establishment of oversight of the decisions of the Council Security on the one hand, and amending the UN Charter to make it more expressive of the aspirations of the international community, referring to the obstacles that prevent this amendment.

Keywords: peace, security, united nations charter, security council, united nations organization

Procedia PDF Downloads 46

Authors: Ryan Villafuerte Lansangan

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Assessing students’ understanding in the microscopic level of an abstract subject like chemistry poses a challenge to teachers. Literature reveals that the use of representations serves as an essential avenue of measuring the extent of understanding in the discipline as an alternative to traditional assessment methods. This undertaking explored the representational competence profile of high school students from the University of Santo Tomas High School in understanding selected chemical principles and correlate this with their academic profile in chemistry based on their performance in the academic achievement examination in chemistry administered by the Center for Education Measurement (CEM). The common misconceptions of the students on the selected chemistry principles based on their representations were taken into consideration as well as the students’ views regarding their understanding of the role of chemical representations in their learning. The students’ level of representation task instrument consisting of the main lessons in chemistry with a corresponding scoring guide was prepared and utilized in the study. The study revealed that most of the students under study are unanimously rated as Level 2 (symbolic level) in terms of their representational competence in understanding the selected chemical principles through the use of chemical representations. Alternative misrepresentations were most observed on the students’ representations on chemical bonding concepts while the concept of chemical equation appeared to be the most comprehensible topic in chemistry for the students. Data implies that teachers’ representations play an important role in helping the student understand the concept in a microscopic level. Results also showed that the academic achievement in the chemistry of the students based on the standardized CEM examination has a significant association with the students’ representational competence. In addition, the students’ responses on the students’ views in chemical representations questionnaire evidently showed a good understanding of what a chemical representation or a mental model is by drawing a negative response that these tools should be an exact replica. Moreover, the students confirmed a greater appreciation that chemical representations are explanatory tools.

Keywords: chemical representations, representational competence, academic profile in chemistry, secondary students

Procedia PDF Downloads 378

Authors: Mrinal Kanti Bhowmik, Debanjana Debnath Jr., Debotosh Bhattacharjee

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A facial expression is undeniably the human manners. It is a significant channel for human communication and can be applied to extract emotional features accurately. People in pain often show variations in facial expressions that are readily observable to others. A core of actions is likely to occur or to increase in intensity when people are in pain. To illustrate the changes in the facial appearance, a system known as Facial Action Coding System (FACS) is pioneered by Ekman and Friesen for human observers. According to Prkachin and Solomon, a set of such actions carries the bulk of information about pain. Thus, the Prkachin and Solomon pain intensity (PSPI) metric is defined. So, it is very important to notice that facial expressions, being a behavioral source in communication media, provide an important opening into the issues of non-verbal communication in pain. People express their pain in many ways, and this pain behavior is the basis on which most inferences about pain are drawn in clinical and research settings. Hence, to understand the roles of different pain behaviors, it is essential to study the properties. For the past several years, the studies are concentrated on the properties of one specific form of pain behavior i.e. facial expression. This paper represents a comprehensive study on pain assessment that can model and estimate the intensity of pain that the patient is suffering. It also reviews the historical background of different pain assessment techniques in the context of painful expressions. Different approaches incorporate FACS from psychological views and a pain intensity score using the PSPI metric in pain estimation. This paper investigates in depth analysis of different approaches used in pain estimation and presents different observations found from each technique. It also offers a brief study on different distinguishing features of real and fake pain. Therefore, the necessity of the study lies in the emerging fields of painful face assessment in clinical settings.

Keywords: facial action coding system (FACS), pain, pain behavior, Prkachin and Solomon pain intensity (PSPI)

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Authors: Nacer Hamza

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Naturally radiation exposure that present due to the cosmic ray or the naturel occurring radioactives materials(NORMs) that originated in the earth's crust and are present everywhere in the environment(1) , a significant concentration of NORMs reported in the produced water which comes out during the oil extraction process, so that the management of this produced water is a challenge for oil and gas companies which include either minimization of produced water which considered as the best way in the term of environment based in the fact that ,the lower water produced the lower cost in treating this water , recycling and reuse by reinjected produced water that fulfills some requirements to enhance oil recovery or disposal in the case that the produced water cannot be minimize or reuse. In the purpose of produced water management, the investigation of NORMs activity concentration present in it considered as the main step for more understanding of the radionuclide’s distribution. Many studies reported the present of NORMs in produced water and investigated the correlation between 〖Ra〗^226and the different metals present in produced water(2) including Cations and anions〖Na〗^+,〖Cl〗^-, 〖Fe〗^(2+), 〖Ca〗^(2+) . and lead, nickel, zinc, cadmium, and copper commonly exist as heavy metal in oil and gas field produced water(3). However, there are no real interesting to investigate the correlation between 〖Rn〗^222and the different metals exist in produced water. methods using, in first to measure the radon concentration activity in produced water samples is a RAD7 .RAD7 is a radiometer instrument based on the solid state detectors(4) which is a type of semi-conductor detector for alpha particles emitting from Rn and their progenies, in second the concentration of different metals presents in produced water measure using an atomic absorption spectrometry AAS. Then to investigate the correlation between the 〖Rn〗^222concentration activity and the metals concentration in produced water a statistical method is Pearson correlation analysis which based in the correlation coefficient obtained between the 〖Rn〗^222 and metals. Such investigation is important to more understanding how the radionuclides act in produced water based on this correlation with metals , in first due to the fact that 〖Rn〗^222decays through the sequence 〖Po〗^218, 〖Pb〗^214, 〖Bi〗^214, 〖Po〗^214, and〖Pb〗^210, those daughters are metals thus they will precipitate with metals present in produced water, secondly the short half-life of 〖Rn〗^222 (3.82 days) lead to faster precipitation of its progenies with metals in produced water.

Keywords: norms, radon concentration, produced water, heavy metals

Procedia PDF Downloads 123

Authors: Jamal Almatawah, Hamad Matar, Abdulsalam Altemeemi

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The World Health Organization (WHO) has recognized environmental noise as harmful pollution that causes adverse psychosocial and physiologic effects on human health. The motor vehicle is considered to be one of the main source of noise pollution. It is a universal phenomenon, and it has grown to the point that it has become a major concern for both the public and policymakers. The aim of this paper, therefore, is to investigate the Traffic noise levels and the contributing factors that affect its level, such as traffic volume, heavy-vehicle Speed and other metrological factors in Ishbiliyah as a sample of a residential area in Kuwait. Three types of roads were selected in Ishbiliyah expressway, major arterial and collector street. The other source of noise that interferes the traffic noise has also been considered in this study. Traffic noise level is measured and analyzed using the Bruel & Kjaer outdoor sound level meter 2250-L (2250 Light). The Count-Cam2 Video Camera has been used to collect the peak and off-peak traffic count. Ambient Weather WM-5 Handheld Weather Station is used for metrological factors such as temperature, humidity and wind speed. Also, the spot speed was obtained using the radar speed: Decatur Genesis model GHD-KPH. All the measurement has been detected at the same time (simultaneously). The results showed that the traffic noise level is over the allowable limit on all types of roads. The average equivalent noise level (LAeq) for the Expressway, Major arterial and Collector Street was 74.3 dB(A), 70.47 dB(A) and 60.84 dB(A), respectively. In addition, a Positive Correlation coefficient between the traffic noise versus traffic volume and between traffic noise versus 85th percentile speed was obtained. However, there was no significant relation and Metrological factors. Abnormal vehicle noise due to poor maintenance or user-enhanced exhaust noise was found to be one of the highest factors that affected the overall traffic noise reading.

Keywords: traffic noise, residential area, pollution, vehicle noise

Procedia PDF Downloads 35

Authors: Hassan Mahmoudzadeh

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The bacterium of Agrobacterium vitis causes crown and root gall disease, an important disease of grapevine, Vitis vinifera L. Also, Phylloxera is one of the most important pests in viticulture. Grapevine rootstocks were developed to provide increased resistance to soil-borne pests and diseases, but rootstock effects on some traits remain unclear. The interaction between rootstock, scion and environment can induce different responses to the grapevine physiology. 'Sultsna' (Vitis vinifera L.) is one of the most valuable raisin grape cultivars in Iran. Thus, the aim of this study was to determine the rootstock effect on the growth characteristics and yield components and quality of 'Sultana' grapevine grown in the Urmia viticulture region. The experimental design was completely randomized blocks, with four treatments, four replicates and 10 vines per plot. The results show that all variables evaluated were significantly affected by the rootstock. The Sultana/110R and Sultana/Nazmieh were among other combinations influenced by the year and had a higher significant yield/vine (13.25 and 12.14, respectively). Indeed, they were higher than that of Sultana/5BB (10.56 kg/vine) and Sultana/Spota (10.25 kg/vine). The number of clusters per burst bud and per vine and the weight of clusters were affected by the rootstock as well. Pruning weight/vine, yield/pruning weight, leaf area/vine and leaf area index are variables related to the physiology of grapevine, which was also affected by the rootstocks. In general, rootstocks had adapted well to the environment where the experiment was carried out, giving vigor and high yield to Sultana grapevine, which means that they may be used by grape growers in this region. In sum, the study found the best rootstocks for 'Sultana' to be Nazmieh and 110R in terms of root and shoot growth. However, the choice of the right rootstock depends on various aspects, such as those related to soil characteristics, climate conditions, grape varieties, and even clones, and production purposes.

Keywords: grafting, vineyards, grapevine, succeptability

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Authors: Alexandre D. Ferraz, Dario H. Alliprandini, Mauro Sampaio

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Companies and other institutions are constantly seeking better organizational performance and greater competitiveness. In order to fulfill this purpose, there are many tools, methodologies and models for increasing performance. However, the Lean Management approach seems to be the most effective in terms of achieving a significant improvement in productivity relatively quickly. Although Lean tools are relatively easy to understand and implement in different contexts, many organizations are not able to transform themselves into 'Lean companies'. Most of the efforts in its implementation have shown single benefits, failing to achieve the desired impact on the performance of the overall enterprise system. There is also a growing perception of the importance of management in Lean transformation, but few studies have empirically investigated and described the 'Lean Management'. In order to understand more clearly the ideas that guide Lean Management and its influence on the maturity level of the production system, the objective of this research is analyze the relationship between the Lean Management principles and the Lean maturity level in the organizations. The research also analyzes the principles of Lean Management and its relationship with the 'Lean culture' and the results obtained. The research was developed using the case study methodology. Three manufacturing units of a German multinational company from industrial automation segment, located in different countries were studied, in order to have a better comparison between the practices and the level of maturity in the implementation. The primary source of information was the application of a research questionnaire based on the theoretical review. The research showed that higher the level of Lean Management principles, higher are the Lean maturity level, the Lean culture level, and the level of Lean results obtained in the organization. The research also showed that factors such as time for application of Lean concepts and company size were not determinant for the level of Lean Management principles and, consequently, for the level of Lean maturity in the organization. The characteristics of the production system showed much more influence in different evaluated aspects. The present research also left recommendations for the managers of the plants analyzed and suggestions for future research.

Keywords: lean management, lean principles, lean maturity level, lean manufacturing

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Authors: Marzieh Khezerloo, Lyazid Djenidi

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Owing to wide range of the micro-device applications, the problems of mixing at small scales is of significant interest. Also, because most of the processes produce heat, it is needed to develop and implement strategies for heat removal in these devices. There are many studies which focus on the effect of roughness or suction on heat transfer performance, separately, although it would be useful to take advantage of these two methods to improve heat transfer performance. Unfortunately, there is a gap in this area. The present numerical study is carried to investigate the combined effects of roughness and wall suction on heat transfer performance of a laminar channel flow; suction is applied on the top and back faces of the roughness element, respectively. The study is carried out for different Reynolds numbers, different suction rates, and various locations of suction area on the roughness. The flow is assumed two dimensional, incompressible, laminar, and steady state. The governing Navier-Stokes equations are solved using ANSYS-Fluent 18.2 software. The present results are tested against previous theoretical results. The results show that by adding suction, the local Nusselt number is enhanced in the channel. In addition, it is shown that by applying suction on the bottom section of the roughness back face, one can reduce the thickness of thermal boundary layer, which leads to an increase in local Nusselt number. This indicates that suction is an effective means for improving the heat transfer rate (suction by controls the thickness of thermal boundary layer). It is also shown that the size and intensity of vortical motion behind the roughness element, decreased with an increasing suction rate, which leads to higher local Nusselt number. So, it can be concluded that by using suction, strategically located on the roughness element, one can control both the recirculation region and the heat transfer rate. Further results will be presented at the conference for coefficient of drag and the effect of adding more roughness elements.

Keywords: heat transfer, laminar flow, numerical simulation, roughness, suction

Procedia PDF Downloads 93

Authors: Alexander A. Tokmakov

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Cell-free protein synthesis is widely used to synthesize recombinant proteins. It allows genome-scale expression of various polypeptides under strictly controlled uniform conditions. However, only a minor fraction of all proteins can be successfully expressed in the systems of protein synthesis that are currently used. The factors determining expression success are poorly understood. At present, the vast volume of data is accumulated in cell-free expression databases. It makes possible comprehensive bioinformatics analysis and identification of multiple features associated with successful cell-free expression. Here, we describe an approach aimed at identification of multiple physicochemical and structural properties of amino acid sequences associated with protein solubility and aggregation and highlight major correlations obtained using this approach. The developed method includes: categorical assessment of the protein expression data, calculation and prediction of multiple properties of expressed amino acid sequences, correlation of the individual properties with the expression scores, and evaluation of statistical significance of the observed correlations. Using this approach, we revealed a number of statistically significant correlations between calculated and predicted features of protein sequences and their amenability to cell-free expression. It was found that some of the features, such as protein pI, hydrophobicity, presence of signal sequences, etc., are mostly related to protein solubility, whereas the others, such as protein length, number of disulfide bonds, content of secondary structure, etc., affect mainly the expression propensity. We also demonstrated that amenability of polypeptide sequences to cell-free expression correlates with the presence of multiple sites of post-translational modifications. The correlations revealed in this study provide a plethora of important insights into protein folding and rationalization of protein production. The developed bioinformatics approach can be of practical use for predicting expression success and optimizing cell-free protein synthesis.

Keywords: bioinformatics analysis, cell-free protein synthesis, expression success, optimization, recombinant proteins

Procedia PDF Downloads 386

Authors: Abhishek Soti, Aditya Sharma, Akhilendra Bhushan Gupta

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Fouled reverse osmosis membranes are primarily characterized by Scanning Electron Microscopy (SEM) and Energy Dispersive X-ray Spectrometer (EDS) for a detailed investigation of foulants; however, this has severe limitations on several accounts. Apart from inaccuracy in spectral properties and inevitable interferences and interactions between sample and instrument, misidentification of elements due to overlapping peaks is a significant drawback of EDS. This paper discusses this limitation by analyzing fouled polyamide RO membranes derived from community RO plants of Rajasthan treating brackish water via a combination of results obtained from EDS and Raman spectroscopy and cross corroborating with ICP-MS analysis of water samples prepared by dissolving the deposited salts. The anomalous behavior of different morphic forms of CaCO₃ in aqueous suspensions tends to introduce false reporting of the presence of certain heavy metals and rare earth metals in the scales of the fouled RO membranes used for treating brackish groundwater when analyzed using the commonly adopted techniques like SEM-EDS or Raman spectrometry. Peaks of CaCO₃ reflected in EDS spectra of the membrane were found to be misinterpreted as Scandium due to the automatic assignment of elements by the software. Similarly, the morphic forms merged with the dominant peak of CaCO₃ might be reflected as a single peak of Molybdenum in the Raman spectrum. A subsequent ICP-MS analysis of the deposited salts showed that both Sc and Mo were below detectable levels. It is always essential to cross-confirm the results through a destructive analysis method to avoid such interferences. It is further recommended to study different morphic forms of CaCO₃ scales, as they exhibit anomalous properties like reverse solubility with temperature and hence altered precipitation tendencies, for an accurate description of the composition of scales, which is vital for the smooth functioning of RO systems.

Keywords: reverse osmosis, foulant analysis, groundwater, EDS, artifacts

Procedia PDF Downloads 53

Authors: Mohamed Saad, Huda Ismail

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The purpose of this research is to examine the impact of cryptocurrency classification on money laundering crimes and to analyze how the preferences of criminals differ according to the type of digital currency used. Specifically, we aim to explore the roles of stablecoins, utility coins, and privacy tokens in facilitating or hindering money laundering activities and to identify the key factors that influence the choices of criminals in using these cryptocurrencies. To achieve our research objectives, we used a dataset for the most highly traded cryptocurrencies (32 currencies) that were published on the coin market cap for 2022. In addition to conducting a comprehensive review of the existing literature on cryptocurrency and money laundering, with a focus on stablecoins, utility coins, and privacy tokens, Furthermore, we conducted several Multivariate analyses. Our study reveals that the classification of cryptocurrency plays a significant role in money laundering activities, as criminals tend to prefer certain types of digital currencies over others, depending on their specific needs and goals. Specifically, we found that stablecoins are more commonly used in money laundering due to their relatively stable value and low volatility, which makes them less risky to hold and transfer. Utility coins, on the other hand, are less frequently used in money laundering due to their lack of anonymity and limited liquidity. Finally, privacy tokens, such as Monero and Zcash, are increasingly becoming a preferred choice among criminals due to their high degree of privacy and untraceability. In summary, our study highlights the importance of understanding the nuances of cryptocurrency classification in the context of money laundering and provides insights into the preferences of criminals in using digital currencies for illegal activities. Based on our findings, our recommendation to the policymakers is to address the potential misuse of cryptocurrencies for money laundering. By implementing measures to regulate stable coins, strengthening cross-border cooperation, fostering public-private partnerships, and increasing cooperation, policymakers can help prevent and detect money laundering activities involving digital currencies.

Keywords: crime, cryptocurrency, money laundering, tokens.

Procedia PDF Downloads 63

Authors: Min Hae Song, Jooyong Park

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Even though assessment using information and communication technology will most likely lead the future of educational assessment, there is little research on this topic. Computerized assessment will not only cut costs but also measure students' performance in ways not possible before. In this context, this study introduces a tool which can overcome the problems of multiple choice tests. Multiple-choice tests (MC) are efficient in automatic grading, however structural problems of multiple-choice tests allow students to find the correct answer from options even though they do not know the answer. A computerized modified multiple-choice testing system (CMMT) was developed using the interactivity of computers, that presents questions first, and options later for a short time when the student requests for them. This study was conducted to find out whether penalizing for wrong answers in CMMT could lower random guessing. In this study, we checked whether students knew the answers by having them respond to the short-answer tests before choosing the given options in CMMT or MC format. Ninety-four students were tested with the directions that they will be penalized for wrong answers, but not for no response. There were 4 experimental conditions: two conditions of high or low percentage of penalizing, each in traditional multiple-choice or CMMT format. In the low penalty condition, the penalty rate was the probability of getting the correct answer by random guessing. In the high penalty condition, students were penalized at twice the percentage of the low penalty condition. The results showed that the number of no response was significantly higher for the CMMT format and the number of random guesses was significantly lower for the CMMT format. There were no significant between the two penalty conditions. This result may be due to the fact that the actual score difference between the two conditions was too small. In the discussion, the possibility of applying CMMT format tests while penalizing wrong answers in actual testing settings was addressed.

Keywords: computerized modified multiple choice test format, multiple-choice test format, penalizing, test format

Procedia PDF Downloads 143

Authors: Apra Sinha

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The inverted U-shaped Environmental Kuznets curve (EKC) demonstrates(pollution-income relationship)that initially the pollution and environmental degradation surpass the level of income per capita; however this trend reverses since at the higher income levels, economic growth initiates environmental upgrading. However, what effect does increased environmental degradation has on growth is the missing feedback link which has not been addressed in the EKC hypothesis. This paper examines the missing feedback link in EKC hypothesis in Indian context by examining the casual association between fossil fuel consumption, carbon dioxide emissions and economic growth for India. Fossil fuel consumption here has been taken as a proxy of driver of economic growth. The casual association between the aforementioned variables has been analyzed using five interventions namely 1) urban development for which urbanization has been taken proxy 2) industrial development for which industrial value added has been taken proxy 3) trade liberalization for which sum of exports and imports as a share of GDP has been taken as proxy 4)financial development for which a)domestic credit to private sector and b)net foreign assets has been taken as proxies. The choice of interventions for this study has been done keeping in view the economic liberalization perspective of India. The main aim of the paper is to investigate the missing feedback link for Environmental Kuznets Curve Hypothesis before and after incorporating the intervening variables. The period of study is from 1971 to 2011 as it covers pre and post liberalization era in India. All the data has been taken from World Bank country level indicators. The Johansen and Juselius cointegration testing methodology and Error Correction based Granger causality have been applied on all the variables. The results clearly show that out of five interventions, only in two interventions the missing feedback link is being addressed. This paper can put forward significant policy implications for environment protection and sustainable development.

Keywords: environmental Kuznets curve hypothesis, fossil fuel consumption, industrialization, trade liberalization, urbanization

Procedia PDF Downloads 225

Authors: Rakan Hassan M. Alzahrani, Ziyad Alzahrani, Bader Bashrahil, Abdulrahman Elyasi, Abdullah a Ghaddaf, Rayan Alzahrani, Mohammed Alkathlan, Nawaf Alghamdi, Dakheelallah Almutairi

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Background: Corticosteroid irrigations, which regularly involve the off-label use of budesonide mixed with normal saline in high volume Sino-nasal irrigations, have been more commonly used in the management of post-operative chronic rhinosinusitis (CRS). Objective: This article attempted to measure the efficacy of post-operative budesonide nasal irrigation compared to normal saline-alone nasal irrigation in the management of chronic rhinosinusitis (CRS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched by two independent authors. Only RCTs comparing budesonide irrigation to normal saline alone irrigation for CRS with or without polyposis after functional endoscopic sinus surgery (FESS) were eligible. A random effect analysis model of the reported CRS-related quality of life (QOL) measures and the objective endoscopic assessment scales of the disease was done. Results: Only 6 RCTs met the eligibility criteria, with a total number of participants of 356. Compared to normal saline irrigation, budesonide nasal irrigation showed statically significant improvements in both the CRS-related quality of life (QOL) and the endoscopic findings (MD= -4.22 confidence interval [CI]: -5.63, -2.82 [P < 0.00001]), (SMD= -0.50 confidence interval [CI]: -0.93, -0.06 [P < 0.03]) respectively. Conclusion: Both intervention arms showed improvements in CRS-related QOL and endoscopic findings in post-FESS chronic rhinosinusitis with or without polyposis. However, budesonide irrigation seems to have a slight edge over conventional normal saline irrigation with no reported serious side effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression.

Keywords: Budesonide, chronic rhinosinusitis, corticosteroids, nasal irrigation, normal saline

Procedia PDF Downloads 51

Authors: Fatemeh Benakashani, Hossein Tavakoli, Elias Soltani

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To ensure the sustainability of crop cultivation and rural economies, it is imperative that we focus on cultivating resilient crops capable of withstanding salt stress. However, the effective management of weeds in salt-affected soils remains a significant challenge. This study investigates the impact of living mulches, specifically Berseem clover (Trifolium alexandrinum) and Barley (Hordeum vulgare), on weed control, as well as the quality and yield of Black cumin (Nigella sativa) in salt-affected soil. In our research, we employed a two-fold mowing strategy for the living mulches: once following crop establishment and once before the flowering stage. Notably, the weed-free plots demonstrated Black cumin's seed yield, and oil content (31.1% to 34.3%), consistent with previous studies, highlighting its potential for the reclamation and utilization of salt-affected lands. However, Black cumin exhibited limited competitiveness against prevalent weeds in the field, such as Amaranthus retroflexus, Chenopodium album, and Portulaca oleracea, which significantly diminished both the 1000 grain mass in plots where weeds were present. Interestingly, the introduction of living mulches led to improvements in seed yield and seed oil content when compared to both weed-free and weed-infested plots. Notably, Berseem clover exhibited greater biomass than Barley, indicating its heightened competitiveness against weeds. Nevertheless, it's worth noting that in the long term, Berseem clover also competed with the main crop, thereby limiting overall productivity. Consequently, we recommend relocating the Berseem clover living mulch following the establishment of Black cumin as a strategy for weed management in Black cumin fields situated in salt-affected soils.

Keywords: weed management, competition, clover, barley, medicinal plant

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Authors: Ferdi Sönmez, Nihal Yorulmaz

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Decision making on the true planning of the public transportation systems to serve potential users is a must for metropolitan areas. To take attraction of travelers to projected modes of transport, adequately fair overall travel times should be provided. In this fashion, other benefits such as lower traffic congestion, road safety and lower noise and atmospheric pollution may be earned. The congestion which comes with increasing demand of public transportation is becoming a part of our lives and making residents’ life difficult. Hence, regulations should be done to reduce this congestion. To provide a constructive and balanced regulation in public transportation systems, right stations should be located in right places. In this study, it is aimed to design and implement a Decision Support System (DSS) Application to determine the optimal bus stop places for public transport in Istanbul which is one of the biggest and oldest cities in the world. Required information is gathered from IETT (Istanbul Electricity, Tram and Tunnel) Enterprises which manages all public transportation services in Istanbul Metropolitan Area. By using the most real-like values, cost assignments are made. The cost is calculated with the help of equations produced by bi-level optimization model. For this study, 300 buses, 300 drivers, 10 lines and 110 stops are used. The user cost of each station and the operator cost taken place in lines are calculated. Some components like cost, security and noise pollution are considered as significant factors affecting the solution of set covering problem which is mentioned for identifying and locating the minimum number of possible bus stops. Preliminary research and model development for this study refers to previously published article of the corresponding author. Model results are represented with the intent of decision support to the specialists on locating stops effectively.

Keywords: operator cost, bi-level optimization model, user cost, urban transportation

Procedia PDF Downloads 214

Authors: Abdullah Alhaqbani

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Purpose: Implementing continuous improvement is a challenge that public sector organisations face in becoming successful. Many obstacles hinder public organisations from successfully implementing continuous improvement. This paper aims to highlight the key core obstacles that face public organisations to implement continuous improvement programmes. Approach: Based on the literature, this paper reviews 66 papers that were published between 2000 and 2013 and that focused on the concept of continuous improvement and improvement methodologies in the context of public sector organisations. The methodologies for continuous improvement covered in these papers include Total Quality Management, Six Sigma, process re-engineering, lean thinking and Kaizen. Findings: Of the 24 obstacles found in the literature, 11 barriers were seen as core barriers that frequently occurred in public sector organisations. The findings indicate that lack of top management commitment; organisational culture and political issues and resistance to change are significant obstacles for improvement programmes. Moreover, this review found that improvement methodologies share some core barriers to successful implementation within public organisations. These barriers as well are common in the different geographic area. For instance lack of top management commitment and training that found in the education sector in Albanian are common barriers of improvement studies in Kuwait, Saudi Arabia, Spain, UK and US. Practical implications: Understanding these core issues and barriers will help managers of public organisations to improve their strategies with respect to continuous improvement. Thus, this review highlights the core issues that prevent a successful continuous improvement journey within the public sector. Value: Identifying and understanding the common obstacles to successfully implementing continuous improvement in the public sector will help public organisations to learn how to improve in launching and successfully sustaining such programmes. However, this is not the end; rather, it is just the beginning of a longer improvement journey. Thus, it is intended that this review will identify key learning opportunities for public sector organisations in developing nations which will then be tested via further research.

Keywords: continuous improvement, total quality management, obstacles, public sector

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Authors: Manuel A. Alonso-Tarajano, Roberto Mosca, Patrick Aloy

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Protein kinases participate in a myriad of cellular processes of major biomedical interest. The in vivo substrate specificity of these enzymes is a process determined by several factors, and despite several years of research on the topic, is still far from being totally understood. In the present work, we have quantified the contributions to the kinase substrate specificity of i) the phosphorylation sites and their surrounding residues in the sequence and of ii) the association of kinases to adaptor or scaffold proteins. We have used position-specific scoring matrices (PSSMs), to represent the stretches of sequences phosphorylated by 93 families of kinases. We have found negative correlations between the number of sequences from which a PSSM is generated and the statistical significance and the performance of that PSSM. Using a subset of 22 statistically significant PSSMs, we have identified specificity determinant residues (SDRs) for 86% of the corresponding kinase families. Our results suggest that different SDRs can function as positive or negative elements of substrate recognition by the different families of kinases. Additionally, we have found that human proteins with known function as adaptors or scaffolds (kAS) tend to interact with a significantly large fraction of the substrates of the kinases to which they associate. Based on this characteristic we have identified a set of 279 potential adaptors/scaffolds (pAS) for human kinases, which is enriched in Pfam domains and functional terms tightly related to the proposed function. Moreover, our results show that for 74.6% of the kinase– pAS association found, the pAS colocalize with the substrates of the kinases they are associated to. Finally, we have found evidence suggesting that the association of kinases to adaptors and scaffolds, may contribute significantly to diminish the in vivo substrate crossed- specificity of protein kinases. In general, our results indicate the relevance of several SDRs for both the positive and negative selection of phosphorylation sites by kinase families and also suggest that the association of kinases to pAS proteins may be an important factor for the localization of the enzymes with their set of substrates.

Keywords: kinase, phosphorylation, substrate specificity, adaptors, scaffolds, cellular colocalization

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Authors: Ayesha Agha Shah

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The purpose of a mosque or a place of worship is to build a spiritual relation with God. If the sense of spirituality is not achieved, then sacred architecture appears to be lacking depth. Form and space play a significant role to enhance the architectural quality to impart a divine feel to a place. To achieve this divine feeling, form and space, and unity of opposites, either abstract or symbolic can be employed. It is challenging to imbue the emptiness of a space with qualitative experience. Mosque architecture mostly entails traditional forms and design typology. This approach for Muslim worship produces distinct landmarks in the urban neighborhoods of Muslim societies, while creating a great sense of spirituality. The universal symbolic characters in the mosque architecture had prototype geometrical forms for a long time in history. However, modern mosques have deviated from this approach to employ different built elements and symbolism, which are often hard to be identified as related to mosques or even as Islamic. This research aims to explore the sense of spirituality in modern mosques and questions whether the modification of geometrical features produce spirituality in the same manner. The research also seeks to investigate the role of ‘geometry’ in the modern mosque architecture. The research employs the analytical study of some modern mosque examples in the Kingdom of Bahrain, reflecting on the geometry and symbolism adopted in the new mosque architecture design. It buttresses the analysis by the engagement of people’s perceptions derived using a survey of opinions. The research expects to see the significance of geometrical architectural elements in the mosque designs. It will find answers to the questions such as; what is the role of the form of the mosque, interior spaces and the effect of the modified symbolic features in the modern mosque design? How can the symbolic geometry, forms and spaces of a mosque invite a believer to leave the worldly environment behind and move towards spirituality?

Keywords: geometry, mosque architecture, spirituality, symbolism

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Authors: Cecil Blake, Tolu Kayode-Adedeji, Innocent Chiluwa, Charles Iruonagbe

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National, regional and international security threats have dominated the twenty-first century thus far. Insurgencies that utilize “terrorism” as their primary strategy pose the most serious threat to global security. States in turn adopt terrorist strategies to resist and even defeat insurgents who invoke the legitimacy of statehood to justify their action. In short, the era is dominated by the use of terror tactics by state and non-state actors. Globally, there is a powerful network of groups involved in insurgencies using Islam as the bastion for their cause. In Africa, there are Boko Haram, Al Shabaab and Al Qaeda in the Maghreb representing Islamic groups utilizing terror strategies and tactics to prosecute their wars. The task at hand is to discover and to use multiple ways of handling the present security threats, including novel approaches to policy formulation, implementation, monitoring and evaluation that would pay significant attention to the important role of culture and communication strategies germane for discursive means of conflict resolution. In other to achieve this, the proposed research would address inter alia, root causes of insurgences that predicate their mission on Islamic tenets particularly in Africa; discursive and non-discursive counter-terrorism approaches fashioned by African governments, continental supra-national and regional organizations, recruitment strategies by major non-sate actors in Africa that rely solely on terrorist strategies and tactics and sources of finances for the groups under study. A major anticipated outcome of this research is a contribution to answers that would lead to the much needed stability required for development in African countries experiencing insurgencies carried out by the use of patterned terror strategies and tactics. The nature of the research requires the use of triangulation as the methodological tool.

Keywords: counter-terrorism, discourse, Nigeria, security, terrorism

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Authors: Azizollah Arbabisarjou, Leila Safabakhsh, Mozhgan Jahantigh, Mahshid Nazemzadeh, Shahindokht Navabi

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Background: Health promotion is an essential strategy for reduction of health disparities. Health promotion includes all activities that encourage optimum physical, spiritual, and mental function. The aim of this study was to determine the impact of a Health Promotion Program (HPP) on behavior in terms of the dimensions of the Health Promoting Lifestyle Profile (HPLP) in patients after Coronary Artery Bypass Graft (CABG). Methods and Materials: In this clinical trial study, 80 patients who had undergone CABG surgery (2011-2012) were selected and randomly divided in two groups: Experimental and Control that investigated by (HPLP II). Then the experimental group was educated about diet, walking and stress management. The program process was followed up for 3months and after that all variables were investigated again. The overall score and the scores for the six dimensions of the HPLP (self-actualization, health responsibility, exercise, nutrition, interpersonal support and stress management) were measured in the pre- and post-test periods. Statistical analysis was performed using Student's t-test and paired t-test. Results: Results showed that Score of stress management (p=.036), diet (p=.002), Spiritual Growth (p=.001) and interrelationship (p=002) increase in experimental group after intervention .Average scores after 3 months in the control group had no significant changes; except responsibility for health (p < .05). Results of the study revealed that comparison the scores of the experimental group were significantly different from the control group in all lifestyle aspects except for spiritual growth. Conclusion: This study showed that Health promoting program on lifestyle and health promotion in patients who suffer from CAD could enhance patient's awareness of healthy behaviors and improves the quality of life.

Keywords: coronary artery bypass graft, health promotion, lifestyle, education

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Authors: Thierry Sammour Sawaya, Heikki Deschacht

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In commercial aircraft operations, almost half of the accidents happen during approach or landing phases. Automatic guidance and automatic landings have proven to bring significant safety value added for this challenging landing phase. This is why Airbus and ScioTeq have decided to work together to explore the capability of image-based landing solutions as additional landing aids to further expand the possibility to perform automatic approach and landing to runways where the current guiding systems are either not fitted or not optimum. Current systems for automated landing often depend on radio signals provided by airport ground infrastructure on the airport or satellite coverage. In addition, these radio signals may not always be available with the integrity and performance required for safe automatic landing. Being independent from these radio signals would widen the operations possibilities and increase the number of automated landings. Airbus and ScioTeq are joining their expertise in the field of Computer Vision in the European Program called Clean Sky 2 Large Passenger Aircraft, in which they are leading the IMBALS (IMage BAsed Landing Solutions) project. The ultimate goal of this project is to demonstrate, develop, validate and verify a certifiable automatic landing system guiding an airplane during the approach and landing phases based on an onboard camera system capturing images, enabling automatic landing independent from radio signals and without precision instrument for landing. In the frame of this project, ScioTeq is responsible for the development of the Image Processing Platform (IPP), while Airbus is responsible for defining the functional and system requirements as well as the testing and integration of the developed equipment in a Large Passenger Aircraft representative environment. The aim of this paper will be to describe the system as well as the associated methods and tools developed for validation and verification.

Keywords: aircraft landing system, aircraft safety, autoland, avionic system, computer vision, image processing

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Authors: Ankush M. Dewle, Suditi Bhattacharya, Prachi R. Abhang, Savita Datar, Ajay J. Jog, Rupesh K. Srivastava, Geetanjali Tomar

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Objectives: The aim of this study was to investigate the quality of mesenchymal stem cells (MSCs) obtained from ageing gingival tissues, in order to suggest their potential role in autologous stem cell therapy for old individuals. Methods: MSCs were isolated from gingival tissues of young (18-45 years) and old (above 45 years) donors by enzymatic digestion. MSCs were analysed for cfu-f, surface marker expression by flow-cytometry and multilineage differentiation potential. The angiogenic potential was compared in a chick embryo yolk sac membrane model. The aging and differentiation markers including SA-β-galactosidase and p21 respectively were analysed by staining and flow-cytometry analysis. Additionally, osteogenic markers such as glucocorticoid receptor (GR), vitamin D receptor (VDR) were measured by flow-cytometry and RT-qPCR was performed for quantification of osteogenic gene expression. Alizarin Red S and alkaline phosphatase (ALP) activity were also quantitated. Results: Gingival MSCs (GMSCs) from both the age groups were similar in their morphology and displayed cfu-f. They had similar expression of MSC surface markers and p21, comparable rate of proliferation and differentiated to all the four lineages. GMSCs from young donors had a higher adipogenic differentiation potential as compared to the old GMSCs. Moreover, these cells did not display a significant difference in ALP activity probably due to comparable expression of GR, VDR, and osteogenic genes. Conclusions: Ageing of GMSCs occurs at a much slower rate than stem cells from other sources. Thus we suggest GMSCs as an excellent candidate for autologous stem cell therapy in degenerative diseases of elderly individuals. Clinical Significance: GMSCs could help overcome the setbacks in clinical implementation of autologous stem cell therapy for regenerative medicine in all age group of patient.

Keywords: bone regeneration, cell therapy, senescence, stem cell

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Authors: Mei Teng Woo, Keith Davids, Jarmo Liukkonen, Jia Yi Chow, Timo Jaakkola

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Wearable garments such as tapes, compression garments, and braces could improve proprioception and reduced postural sway. The aim of this study was to examine the effects of wearable garments on postural regulation in a sample of community-dwelling elderly individuals, aged 65 years. It was hypothesized that wearable garments such as socks would provide stimulation to lower leg mechanoreceptors, and help participants achieve better postural regulation. Participants (N=63) performed a 30-s Romberg balance test protocol under four conditions (barefoot; wearing commercial socks; wearing clinical compression socks; wearing non-clinical compression socks), in a counterbalanced order, with four levels of performance difficulty: (1) standing on a stable surface with open eyes (SO); (2) a stable surface with closed eyes (SC); (3) a foam surface with open eyes (FO); and (4) a foam surface with closed eyes (FC). Centre of pressure (CoP) measurements included postural sway area (C90 area), trace length (TL) and sway velocity. Thirty-five participants (55.6%) showed positive effects of wearing the socks (responded group). In the responded group, it was revealed that socks showed significant differences in SO, SC and FO conditions for the two CoP measurements - TL and sway velocity (p < 0.05). In contrast, in the non-responded group, barefoot condition significantly decreased the TL and velocity in the SO condition. From the positive effects observed in the responded group, it is possible that wearable garments provide sensory cues that could interact with a biological cueing system to enhance performance in the postural regulation system. This study suggests that individuals respond to the socks treatments differently and future research should be undertaken to examine the factors that benefited the responded group of participants.

Keywords: community-dwelling, elderly adults, postural regulation, wearable garments

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Authors: Funmilayo Sarah Eguakun, Peter Oluremi Adesoye

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One of the major problems being faced by human society is that the global temperature is believed to be rising due to human activity that releases carbon IV oxide (CO2) to the atmosphere. Carbon IV oxide is the most important greenhouse gas influencing global warming and possible climate change. With climate change becoming alarming, reducing CO2 in our atmosphere has become a primary goal of international efforts. Forest landsare major sink and could absorb large quantities of carbon if the trees are judiciously managed. The study aims at estimating the carbon sequestration capacity of Pinus caribaea (pine)and Tectona grandis (Teak) under the prevailing environmental conditions and exploring tree growth variables that influencesthe carbon sequestration capacity in Omo Forest Reserve, Ogun State, Nigeria. Improving forest management by manipulating growth characteristics that influences carbon sequestration could be an adaptive strategy of forestry to climate change. Random sampling was used to select Temporary Sample Plots (TSPs) in the study area from where complete enumeration of growth variables was carried out within the plots. The data collected were subjected to descriptive and correlational analyses. The results showed that average carbon stored by Pine and Teak are 994.4±188.3 Kg and 1350.7±180.6 Kg respectively. The difference in carbon stored in the species is significant enough to consider choice of species relevant in climate change adaptation strategy. Tree growth variables influence the capacity of the tree to sequester carbon. Height, diameter, volume, wood density and age are positively correlated to carbon sequestration. These tree growth variables could be manipulated by the forest manager as an adaptive strategy for climate change while plantations of high wood density speciescould be relevant for management strategy to increase carbon storage.

Keywords: adaptation, carbon sequestration, climate change, growth variables, wood density

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Authors: Katalin Gocze, Vanda A Nemes, Charlotte Briest

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Introduction: Premenstrual syndrome (PMS) is a psychoneuroendocrinological disorder adversely affecting life-quality for over 80% of hormonally active women. PMS has a negative impact on women’s daily life in terms of work, interpersonal relationships and leisure time activities. The aim of our study was to evaluate the effects of a yoga intervention focusing on the female pelvic area. Materials and methods: 34 women (ages 18-40) with PMS (Premenstrual Syndrome Screening Tool) and no previous experience in yoga were recruited and randomly assigned to either the yoga or the control group. The intervention consisted of 90’ yoga sessions twice a week and a daily 15’ self-practice module with carefully chosen yogic exercises addressing the reproductive organs by toning the pelvic floor and opening the hips as well as relieving stress and improving concentration. Severity of symptoms of PMS was assessed at the beginning and after the 8-week-long intervention. Pre- and post-program data collection included physical and psychological parameters and the evaluation of ACOQ PMS questionnaire and daily symptom diary. Results: Age and educational background were similar in the control and intervention group with an overall mean age of 29.11±4.78 years. PSST scores significantly improved in the yoga group (p=0.002), while difference in the control group’s pre and post-program values were non-significant (p=0.38). Perception and tolerance of anxiety and stress was significantly better after the intervention (p=0.008). As for changes in physical symptoms distinct improvement was registered for breast tenderness (p=0.028) and for meteorism (p=0.015). Discussion: Yoga’s success originates from the synergic positive effects of stress relief and regular physical activity. Benefits (both mental and physical) of strategically planned, focused yoga practice are apparent even after shorter time periods and can help women with PMS manage or eliminate symptoms in order to improve their life-quality.

Keywords: life-quality, physical symptoms, premenstrual syndrome, psychological impact, yoga

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Authors: Somyoung Shin, Donghun Jeong, Yeoil Yun

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South Korea continuously installed tunnels in consideration of the safety and operation efficiency, and the number of installed tunnels has doubled over the past ten years. The tunnel section is designed based on the guidelines, but the tunnel entrance becomes narrow due to dark adaptation and pressure. In fact, around 13% of traffic in expressways of Japan happens at the entrance, leading to congestion and rear-ends collision accidents. Therefore, this study aims to analyze the stability from the expansion of the shoulder width in the tunnel entrance by applying a virtual reality driving simulator in order to reduce the accidents that happen in the tunnel entrance. To compare the driving stability based on the changes in the width of the right shoulder under the same condition, a virtual reality driving simulator is used to conduct an experiment on 30 subjects in their 20s to 60s and to provide a more practical virtual reality driving environment, and an experiment map is designed based on actual roads as the background to conduct the experiment. The right shoulder is classified into 2.5m and 3.0m based on the design guidelines of the expressways and the road structure installation regulations. The experimenters' experiment order is decided randomly. As a result of analyzing the average speed, it was displayed as 100.73km/h when the shoulder width was 2.5m and 101.69km/h when the shoulder width was 3.0m and as a result of conducting t-test analysis, the p-value appeared as more than 0.05 in the significance level of 95%, so it was statistically insignificant. Also, as a result of analyzing the speed deviation between the average driving speed of the analyzed interval and the average driving speed upon entering the tunnel, it was displayed as 3.06km/h when the shoulder width was 2.5m and 1.87km/h when the shoulder width was 3.0m and as a result of conducting t-test analysis, the p-value appeared as less than 0.05 in the significance level of 95%, so it was statistically significant. This means that when the shoulder width is 3.0m, there is stability in terms of the driving stability compared to when it is 2.5m. Therefore, it is considered that when new roads are constructed in Korea, the right shoulder width should be installed as 3.0m to enhance the driving stability.

Keywords: driving stability, shoulder width, tunnel, virtual reality driving simulator

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Authors: Bekir Turedi

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Exploiting the potential of perovskite single-crystal solar cells in optoelectronic applications necessitates overcoming a significant challenge: the low charge collection efficiency at increased thickness, which has restricted their deployment in radiation detectors and nuclear batteries. Our research details a promising approach to this problem, wherein we have successfully fabricated single-crystal MAPbI3 solar cells employing a space-limited inverse temperature crystallization (ITC) methodology. Remarkably, these cells, up to 400-fold thicker than current-generation perovskite polycrystalline films, maintain a high charge collection efficiency even without external bias. The crux of this achievement lies in the long electron diffusion length within these cells, estimated to be around 0.45 mm. This extended diffusion length ensures the conservation of high charge collection and power conversion efficiencies, even as the thickness of the cells increases. Fabricated cells at 110, 214, and 290 µm thickness manifested power conversion efficiencies (PCEs) of 20.0, 18.4, and 14.7% respectively. The single crystals demonstrated nearly optimal charge collection, even when their thickness exceeded 200 µm. Devices of thickness 108, 214, and 290 µm maintained 98.6, 94.3, and 80.4% of charge collection efficiency relative to their maximum theoretical short-circuit current value, respectively. Additionally, we have proposed an innovative, self-consistent technique for ascertaining the electron-diffusion length in perovskite single crystals under operational conditions. The computed electron-diffusion length approximated 446 µm, significantly surpassing previously reported values for this material. In conclusion, our findings underscore the feasibility of fabricating halide perovskite single-crystal solar cells of hundreds of micrometers in thickness while preserving high charge extraction efficiency and PCE. This advancement paves the way for developing perovskite-based optoelectronics necessitating thicker active layers, such as X-ray detectors and nuclear batteries.

Keywords: perovskite, solar cell, single crystal, diffusion length

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Authors: Maria Ahmad, Alexandra Valetopoulou, Michael D. Christian

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Background: London’s Air Ambulance (LAA) provides advanced pre-hospital trauma care across London, bringing specialist resources and expert trauma teams to patients. Since its inception 32 years ago, LAA has treated over 40,000 pre-hospital patients and significantly contributed to pre-hospital patient care in London. To the authors’ best knowledge, this is the first analysis to quantify the magnitude of the publication impact of LAA on the international field of pre-hospital medicine. Method: We searched the Scopus, Web of Science, Google Scholar and PubMed databases to identify LAA focused articles. These were defined as articles on the topic of pre-hospital medicine which either utilised data from LAA, or focused on LAA patients, or were authored by LAA clinicians. A bibliometric analysis was conducted and the impact of each eligible article was classified as either: high (article directly influenced the change or creation of clinical guidelines); medium (the article was referenced in clinical guidelines or had >20 Google Scholar citations or >10 PubMed citations); or low impact (article had <20 Google Scholar citations or <10 PubMed citations). Results: The literature search yielded 1,120 articles in total. 198 articles met our inclusion criteria, and their full text was analysed to determine the level of impact. 19 articles were classified as high-impact, 76 as medium-impact, and 103 as low-impact. 20 of the 76 medium-impact articles were referenced in clinical guidelines but had not prompted changes to the guidelines. Conclusion: To our knowledge, this review is the first to quantify the significant publication impact of LAA within the field of pre-hospital medicine over the last 32 years. LAA publications have focused on and driven clinical innovations in trauma care, particularly in pre-hospital anaesthesia, haemorrhage control, and major incidents, with many impacting national and international guidelines. We recommend a greater emphasis on multidisciplinary pre-hospital collaboration in publications in future research and quality improvement projects across all pre-hospital services.

Keywords: air ambulance, pre-hospital medicine, London’s Air Ambulance, London HEMS

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