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Authors: Ion Miciu

Abstract:

The system is made with main distributed components: First Level: Industrial Computers placed in Control Room (monitors thermal and electrical processes based on the data provided by the second level); Second Level: PLCs which collects data from process and transmits information on the first level; also takes commands from this level which are further, passed to execution elements from third level; Third Level: field elements consisting in 3 categories: data collecting elements; data transfer elements from the third level to the second; execution elements which take commands from the second level PLCs and executes them after which transmits the confirmation of execution to them. The purpose of the automatic functioning is the optimization of the co-generative electrical energy commissioning in the national energy system and the commissioning of thermal energy to the consumers. The integrated system treats the functioning of all the equipments and devices as a whole: Gas Turbine Units (GTU); MT 20kV Medium Voltage Station (MVS); 0,4 kV Low Voltage Station (LVS); Main Hot Water Boilers (MHW); Auxiliary Hot Water Boilers (AHW); Gas Compressor Unit (GCU); Thermal Agent Circulation Pumping Unit (TPU); Water Treating Station (WTS).

Keywords: Automation System, Cogenerative Power Plant, Control, Monitoring, Real Time

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Authors: Benshi Zhu

Abstract:

In this paper, the existence of multiple positive solutions for a class of third-order three-point discrete boundary value problem is studied by applying algebraic topology method.

Keywords: Positive solutions, Discrete boundary value problem, Third-order, Three-point, Algebraic topology

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Authors: S. Hasan, I. Beshara

Abstract:

Infrastructure maintenance is a great challenge facing sustainable development of infrastructure assets due to the high cost of passive implementation of a sustainable maintenance plan. An assessment model of sustainable maintenance for highway infrastructure projects in Egypt is developed in this paper. It helps in improving the implementation of sustainable maintenance criteria. Thus, this paper has applied the analytical hierarchy processes (AHP) to rank and explore the weight of 26 assessment indicators using three hierarchy levels containing the main sustainable categories and subcategories with related indicators. Overall combined weight of each indicator for sustainable maintenance evaluation has been calculated to sum up to a sustainable maintenance performance index (SMI). The results show that the factor "Preventive maintenance cost" has the highest relative contribution factor among others (13.5%), while two factors of environmental performance have the least weights (0.7%). The developed model aims to provide decision makers with information about current maintenance performance and support them in the decision-making process regarding future directions of maintenance activities. It can be used as an assessment performance tool during the operation and maintenance stage. The developed indicators can be considered during designing the maintenance plan. Practices for successful implementation of the model are also presented.

Keywords: Analytical Hierarchy Process, AHP, assessment performance model, KPIs for sustainable maintenance, sustainable maintenance index.

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Authors: Daniel L. Clinciu, Ikrom Abdulaev, Brian D. Oscar

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Various personality profile tests are used to identify personality strengths and limits in individuals, helping both individuals and managers to optimize work and team effort in organizations. One such test, the Hartman’s personality profile, emphasizes four driving "core motives" influenced or affected by both strengths and limitations classified into four colors: Red - motivated by power; Blue - discipline and loyalty; White - peace; and Yellow – fun loving. Two shortcomings of Hartman’s personality test are noted; 1) only one selection for every item / situation allowed and 2) selection of an item / option even if not applicable. A test taker may be as much nurturing as he is opinionated but since “opinionated” seems less attractive the individual would likely select nurturing, causing a misidentification in personality strengths and limits. Since few individuals have a “strong” personality, it is difficult to assess their true personality strengths and limits allowing only one choice or requiring unwanted choices, undermining the potential of the test. We modified Hartman’s personality profile allowing test takers to make either multiple choices for any item / situation or leave them blank if applicable. Sixty-eight participants (38 males and 30 females), 17 - 49 years old, from countries in Asia, Europe, N. America, CIS, Africa, Latin America, and Oceania were included. 58 participants (85.3%) reported the modified test, allowing multiple / no choices better identified their personality strengths and limits, while 10 participants (14.7%) expressed the original (one choice version) was sufficient. The overall results show that our modified test enhanced the identification and balance of core personalities’ strengths and limits, aiding test takers, managers and organizations to better assess individual characteristics, particularly useful in making task-related, teamwork, and management decisions.

Keywords: Organizational behavior, personality tests, personality limitations, personality strengths, task management, team work.

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Authors: Rui Wu, Tapani Ristaniemi

Abstract:

In this paper, we propose a new algorithm for joint time-delay and direction-of-arrival (DOA) estimation, here called two-dimensional code acquisition, in an asynchronous directsequence code-division multiple-access (DS-CDMA) array system. This algorithm depends on eigenvector-eigenvalue decomposition of sample correlation matrix, and requires to know desired user-s training sequence. The performance of the algorithm is analyzed both analytically and numerically in uncorrelated and coherent multipath environment. Numerical examples show that the algorithm is robust with unknown number of coherent signals.

Keywords: Two-Dimensional Code Acquisition, EV-t, DSCDMA

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Authors: Onkar Bhat Kodical, Sridhar Srinivasan, N.K. Srinath

Abstract:

Tool Tracker is a client-server based application. It is essentially a catalogue of various network monitoring and management tools that are available online. There is a database maintained on the server side that contains the information about various tools. Several clients can access this information simultaneously and utilize this information. The various categories of tools considered are packet sniffers, port mappers, port scanners, encryption tools, and vulnerability scanners etc for the development of this application. This application provides a front end through which the user can invoke any tool from a central repository for the purpose of packet sniffing, port scanning, network analysis etc. Apart from the tool, its description and the help files associated with it would also be stored in the central repository. This facility will enable the user to view the documentation pertaining to the tool without having to download and install the tool. The application would update the central repository with the latest versions of the tools. The application would inform the user about the availability of a newer version of the tool currently being used and give the choice of installing the newer version to the user. Thus ToolTracker provides any network administrator that much needed abstraction and ease-ofuse with respect to the tools that he can use to efficiently monitor a network.

Keywords: Network monitoring, single platform, client/server application, version management.

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Authors: Simon B. N. Thompson

Abstract:

Cortisol is essential to the regulation of the immune system and pathological yawning is a symptom of multiple sclerosis (MS). Electromyography activity (EMG) in the jaw muscles typically rises when the muscles are moved – extended or flexed; and yawning has been shown to be highly correlated with cortisol levels in healthy people as shown in the Thompson Cortisol Hypothesis. It is likely that these elevated cortisol levels are also seen in people with MS. The possible link between EMG in the jaw muscles and rises in saliva cortisol levels during yawning were investigated in a randomized controlled trial of 60 volunteers aged 18-69 years who were exposed to conditions that were designed to elicit the yawning response. Saliva samples were collected at the start and after yawning, or at the end of the presentation of yawning-provoking stimuli, in the absence of a yawn, and EMG data was additionally collected during rest and yawning phases. Hospital Anxiety and Depression Scale, Yawning Susceptibility Scale, General Health Questionnaire, demographic, and health details were collected and the following exclusion criteria were adopted: chronic fatigue, diabetes, fibromyalgia, heart condition, high blood pressure, hormone replacement therapy, multiple sclerosis, and stroke. Significant differences were found between the saliva cortisol samples for the yawners, t (23) = -4.263, p = 0.000, as compared with the non-yawners between rest and poststimuli, which was non-significant. There were also significant differences between yawners and non-yawners for the EMG potentials with the yawners having higher rest and post-yawning potentials. Significant evidence was found to support the Thompson Cortisol Hypothesis suggesting that rises in cortisol levels are associated with the yawning response. Further research is underway to explore the use of cortisol as a potential diagnostic tool as an assist to the early diagnosis of symptoms related to neurological disorders. Bournemouth University Research & Ethics approval granted: JC28/1/13-KA6/9/13. Professional code of conduct, confidentiality, and safety issues have been addressed and approved in the Ethics submission. Trials identification number: ISRCTN61942768. http://www.controlled-trials.com/isrctn/

Keywords: Cortisol, Electromyography, Neurology, Yawning.

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Authors: Yunos Zahri, Ab Hamid R. Susanty, Ahmad Mustaffa

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This paper explores the need for a national baseline study on understanding the level of cyber security situational awareness among primary and secondary school students in Malaysia. The online survey method was deployed to administer the data collection exercise. The target groups were divided into three categories: Group 1 (primary school aged 7-9 years old), Group 2 (primary school aged 10-12 years old), and Group 3 (secondary school aged 13-17 years old). A different questionnaire set was designed for each group. The survey topics/areas included Internet and digital citizenship knowledge. Respondents were randomly selected from rural and urban areas throughout all 14 states in Malaysia. A total of 9,158 respondents participated in the survey, with most states meeting the minimum sample size requirement to represent the country’s demographics. The findings and recommendations from this baseline study are fundamental to develop teaching modules required for children to understand the security risks and threats associated with the Internet throughout their years in school. Early exposure and education will help ensure healthy cyber habits among millennials in Malaysia.

Keywords: Cyber security awareness, cyber security education, cyber security, students.

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Authors: Mazdak Zamani , Azizah A. Manaf , Rabiah B. Ahmad , Akram M. Zeki , Shahidan Abdullah

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In this paper, we present a novel, principled approach to resolve the remained problems of substitution technique of audio steganography. Using the proposed genetic algorithm, message bits are embedded into multiple, vague and higher LSB layers, resulting in increased robustness. The robustness specially would be increased against those intentional attacks which try to reveal the hidden message and also some unintentional attacks like noise addition as well.

Keywords: Artificial Intelligence, Audio Steganography, DataHiding, Genetic Algorithm, Substitution Techniques.

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Authors: Ki-Young Kim, Jae-Ho Lim, Deok-Min Kim, Seok-Yoon Kim

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Average current analysis checking the impact of current flow is very important to guarantee the reliability of semiconductor systems. As semiconductor process technologies improve, the coupling capacitance often become bigger than self capacitances. In this paper, we propose an analytic technique for analyzing average current on interconnects in multi-conductor structures. The proposed technique has shown to yield the acceptable errors compared to HSPICE results while providing computational efficiency.

Keywords: current moment, interconnect modeling, reliability analysis, worst-case switching

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Authors: Sheroz Khan, A. F. Salami, W. A. Lawal, AHM Zahirul Alam, Shihab Abdel Hameed, M. J. E.Salami

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In this paper, a multi-branch power line is modeled using ABCD matrix to show its worth as a communication channel. The model is simulated using MATLAB in an effort to investigate the effects of multiple loading, multipath, and those as a result of load mismatching. The channel transfer function is obtained and investigated using different cable lengths, and different number of bridge taps under given loading conditions.

Keywords: Power line Communication, Transfer Function, Channel Modeling, Signal Transmission.

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Authors: Pathinathan Theresanathan, Ajay Minj

Abstract:

Ignatian Discernment Process (IDP) is an intense decision-making tool to decide on life-issues. Decisions are influenced by various factors outside of the decision maker and inclination within. This paper develops IDP in the context of Fuzzy Multi-criteria Decision Making (FMCDM) process. Extended VIKOR method is a decision-making method which encompasses even conflict situations and accommodates weightage to various issues. Various aspects of IDP, namely three ways of decision making and tactics of inner desires, are observed, analyzed and articulated within the frame work of fuzzy rules. The decision-making situations are broadly categorized into two types. The issues outside of the decision maker influence the person. The inner feeling also plays vital role in coming to a conclusion. IDP integrates both the categories using Extended VIKOR method. Case studies are carried out and analyzed with FMCDM process. Finally, IDP is verified with an illustrative case study and results are interpreted. A confused person who could not come to a conclusion is able to take decision on a concrete way of life through IDP. The proposed IDP model recommends an integrated and committed approach to value-based decision making.

Keywords: Analytical hierarchy process, fuzzy multi-criteria decision making, Ignatian discernment process, Ignatian discernment, multi-criteria decision making, VIKOR.

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Authors: Richard A. Wasniowski

Abstract:

In this paper we propose a framework for multisensor intrusion detection called Fuzzy Agent-Based Intrusion Detection System. A unique feature of this model is that the agent uses data from multiple sensors and the fuzzy logic to process log files. Use of this feature reduces the overhead in a distributed intrusion detection system. We have developed an agent communication architecture that provides a prototype implementation. This paper discusses also the issues of combining intelligent agent technology with the intrusion detection domain.

Keywords: Intrusion detection, fuzzy logic, agents, networksecurity.

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Authors: Nagmani Lnu

Abstract:

Test automation is a vital requirement of any organization to release products faster to their customers. In most cases, an organization has an approach to developing automation but struggles to maintain it. It results in an increased number of flaky tests, reducing return on investments and stakeholders’ confidence. Challenges grow in multiple folds when automation is for User Interface (UI) behaviors. This paper describes the approaches taken to identify the root cause of automation instability in an extensive payments application and the best practices to address that using processes, tools, and technologies, resulting in a 75% reduction of effort.

Keywords: Automation stability, test stability, flaky test, test quality, test automation quality.

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Authors: K. R. V. Manikantachari, Vasudevan Raghavan, K. Srinivasan

Abstract:

Present study focuses on studying the oscillatory behavior of jet diffusion flames. At a particular jet exit velocity, the flames are seen to exhibit natural flickering. Initially the flickering process is not continuous. In this transition region as well as in the continuous flickering regime, the flickering displays multiple frequency oscillations. The response of the flame to the exit velocity profile of the burner is also studied using three types of burners. The entire range of natural flickering is investigated by capturing high speed digital images and processing them using a MATLAB code.

Keywords: Diffusion flames, Natural flickering, flickering frequency, intermittent flickering

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Authors: Yan Shuang Zhang, Taehan Lee, Byung Ho Jeong

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A DEA model can generally evaluate the performance using multiple inputs and outputs for the same period. However, it is hard to avoid the production lead time phenomenon some times, such as long-term project or marketing activity. A couple of models have been suggested to capture this time lag issue in the context of DEA. This paper develops a dual-MPO model to deal with time lag effect in evaluating efficiency. A numerical example is also given to show that the proposed model can be used to get efficiency and reference set of inefficient DMUs and to obtain projected target value of input attributes for inefficient DMUs to be efficient.

Keywords: DEA, efficiency, time lag, dual problem.

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Authors: Sing-Han Wang, Shiang-Hwua Yu, Chih-Po Yang

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Repetitive control and feedback dithering modulation are applied to a single-phase voltage source inverter, with an aim to eliminate harmonics and stabilize the inverter under load variations. The proposed control and modulation scheme comprise multiple loops of feedback, which helps improve inverter performance and robustness. Experimental results show that the designed inverter exhibits very low distortion at its output with THD of about 0.3% under different load variations.

Keywords: Feedback dithering modulation, repetitive control, state feedback, inverter, harmonics elimination.

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Authors: Thipwimon Chungsangunsit, Shabbir H. Gheewala, Suthum Patumsawad

Abstract:

Rice husk is one of the alternative fuels for Thailand because of its high potential and environmental benefits. Nonetheless, the environmental profile of the electricity production from rice husk must be assessed to ensure reduced environmental damage. A 10 MW pilot plant using rice husk as feedstock is the study site. The environmental impacts from rice husk power plant are evaluated by using the Life Cycle Assessment (LCA) methodology. Energy, material and carbon balances have been determined for tracing the system flow. Carbon closure has been used for describing of the net amount of CO2 released from the system in relation to the amount being recycled between the power plant and the CO2 adsorbed by rice husk. The transportation of rice husk to the power plant has significant on global warming, but not on acidification and photo-oxidant formation. The results showed that the impact potentials from rice husk power plant are lesser than the conventional plants for most of the categories considered; except the photo-oxidant formation potential from CO. The high CO from rice husk power plant may be due to low boiler efficiency and high moisture content in rice husk. The performance of the study site can be enhanced by improving the combustion efficiency.

Keywords: Environmental impact, Fossil fuels, Life Cycle Assessment (LCA), Renewable energy, Rice husk

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Authors: Julinda Keçi

Abstract:

In many countries, governments have been promoting the involvement of private sector entities to enter into long-term agreements for the development and delivery of large infrastructure projects, with a focus on overcoming the limitations upon public fund of the traditional approach. The involvement of private sector through public private partnerships (PPP) brings in new capital investments, value for money and additional risks to handle. Worldwide research studies have shown that an objective, systematic, reliable and useroriented risk assessment process and an optimal allocation mechanism among different stakeholders is crucial to the successful completion. In this framework, this paper, which is the first stage of a research study, aims to identify the main risks for the delivery of PPP projects. A review of cross-countries research projects and case studies was performed to map the key risks affecting PPP infrastructure delivery. The matrix of mapping offers a summary of the frequency of factors, clustered in eleven categories: construction, design, economic, legal, market, natural, operation, political, project finance, project selection and relationship. Results will highlight the most critical risk factors, and will hopefully assist the project managers in directing the managerial attention in the further stages of risk allocation.

Keywords: Construction, infrastructure, public private partnerships, risks.

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Authors: K. Reitner, F. Staberhofer, W. Ortner, M. Gerschberger

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The purpose of this paper is to identify the main challenges faced by companies in the timber construction sector and to provide improvement opportunities that can be implemented on a short-, medium- and long-term basis. To identify the challenges and propose actions for each company a literature review and a multiple case research were conducted using the Quick Scan Audit Methodology. Finally, the findings and outcomes are compared with each other to support companies in the timer construction sector when implementing and restructuring their day-to-day activities.

Keywords: Supply chain management, supply chain challenges and opportunities, timber construction sector.

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Authors: Zhouhong Li, Jiming Yang

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In this paper, a class of predator-prey-chain model with harvesting terms are studied. By using Mawhin-s continuation theorem of coincidence degree theory and some skills of inequalities, some sufficient conditions are established for the existence of eight positive periodic solutions. Finally, an example is presented to illustrate the feasibility and effectiveness of the results.

Keywords: Positive periodic solutions, Predator-prey-chain model, coincidence degree, harvesting term.

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Authors: Qiuling Xie, Shanliang Zhu, Zongdi Sun

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In this paper, we analyzed the correlation relationship among PM2.5 from other five Air Quality Indices (AQIs) based on the grey relational degree, and built a multivariate nonlinear regression equation model of PM2.5 and the five monitoring indexes. For the optimal control problem of PM2.5, we took the partial large Cauchy distribution of membership equation as satisfaction function. We established a nonlinear programming model with the goal of maximum performance to price ratio. And the optimal control scheme is given.

Keywords: Grey relational degree, multiple linear regression, membership function, nonlinear programming.

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Authors: Ramaswamy Palaniappan, Nai-Jen Huan

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Classification of electroencephalogram (EEG) signals extracted during mental tasks is a technique that is actively pursued for Brain Computer Interfaces (BCI) designs. In this paper, we compared the classification performances of univariateautoregressive (AR) and multivariate autoregressive (MAR) models for representing EEG signals that were extracted during different mental tasks. Multilayer Perceptron (MLP) neural network (NN) trained by the backpropagation (BP) algorithm was used to classify these features into the different categories representing the mental tasks. Classification performances were also compared across different mental task combinations and 2 sets of hidden units (HU): 2 to 10 HU in steps of 2 and 20 to 100 HU in steps of 20. Five different mental tasks from 4 subjects were used in the experimental study and combinations of 2 different mental tasks were studied for each subject. Three different feature extraction methods with 6th order were used to extract features from these EEG signals: AR coefficients computed with Burg-s algorithm (ARBG), AR coefficients computed with stepwise least square algorithm (ARLS) and MAR coefficients computed with stepwise least square algorithm. The best results were obtained with 20 to 100 HU using ARBG. It is concluded that i) it is important to choose the suitable mental tasks for different individuals for a successful BCI design, ii) higher HU are more suitable and iii) ARBG is the most suitable feature extraction method.

Keywords: Autoregressive, Brain-Computer Interface, Electroencephalogram, Neural Network.

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Authors: Osa D Egonwa

Abstract:

In the 21^st century, the disciplinary boundaries of past centuries that we often create through mainstream art historical classification, techniques and sources may have been eroded by visual culture, which seems to provide a more inclusive umbrella for the new ways artists go about the creative process and its resultant commodities. Over the past four decades, artists in Africa have resorted to new materials, techniques and themes which have affected our ways of research on these artists and their art. Frontline artists such as El Anatsui, Yinka Shonibare, Erasmus Onyishi are demonstrating that any material is just suitable for artistic expression. Most of times, these materials come with their own techniques/effects and visual syntax: a combination of materials compounds techniques, formal aesthetic indexes, halo effects, and iconography. This tends to challenge the categories and we lean on to view, think and talk about them. This renders our main stream art historical research methods inadequate, thus suggesting new discursive concepts, terms and theories. This paper proposed the Africanist eclectic methods derived from the dual framework of Masquerade Theory and What Comes Behind Six is More Than Seven. This paper shares thoughts/research on art historical methods, terminological re-alignments on classification/source data, presentational format and interpretation arising from the emergent trends in our subject. The outcome provides useful tools to mediate new thoughts and experiences in recent African art and visual culture.

Keywords: Art Historical Methods, Classifications, Concepts , Re-alignment.

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Authors: Adel Hamad Rafa

Abstract:

This paper, proposes a control system for use with microgrid consiste of  multiple small scale embedded generation networks (SSEG networks) connected to the 33kV distribution network. The proposed controller controls power flow in the grid-connected mode of operation, enables voltage and frequency control when the SSEG networks are islanded, and resynchronises the SSEG networks with the utility before reconnecting them. The performance of the proposed controller has been tested in simulations using PSCAD.

Keywords: Microgrid, Small scale embedded generation, island mode, resynchronisation.

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Authors: Hui-Chuan Chu, Min-Ju Liao, Wei-Kai Cheng, William Wei-Jen Tsai, Yuh-Min Chen

Abstract:

Avoiding learning failures in mathematics e-learning environments caused by emotional problems in students with autism has become an important topic for combining of special education with information and communications technology. This study presents an adaptive emotional adjustment model in mathematics e-learning for students with autism, emphasizing the lack of emotional perception in mathematics e-learning systems. In addition, an emotion classification for students with autism was developed by inducing emotions in mathematical learning environments to record changes in the physiological signals and facial expressions of students. Using these methods, 58 emotional features were obtained. These features were then processed using one-way ANOVA and information gain (IG). After reducing the feature dimension, methods of support vector machines (SVM), k-nearest neighbors (KNN), and classification and regression trees (CART) were used to classify four emotional categories: baseline, happy, angry, and anxious. After testing and comparisons, in a situation without feature selection, the accuracy rate of the SVM classification can reach as high as 79.3-%. After using IG to reduce the feature dimension, with only 28 features remaining, SVM still has a classification accuracy of 78.2-%. The results of this research could enhance the effectiveness of eLearning in special education.

Keywords: Emotion classification, Physiological and facial Expression measures, Students with autism, Mathematics e-learning.

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Authors: Masaumi Nakahara, Sou Watanabe, Hiromichi Ogi, Atsuhiro Shibata, Kazunori Nomura

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In the Japan Atomic Energy Agency, three types of experimental research, advanced reactor fuel reprocessing, radioactive waste disposal, and nuclear fuel cycle technology, have been carried out at the Chemical Processing Facility. The facility has generated high level radioactive liquid and solid wastes in hot cells. The high level radioactive solid waste is divided into three main categories, a flammable waste, a non-flammable waste, and a solid reagent waste. A plastic product is categorized into the flammable waste and molten with a heating mantle. The non-flammable waste is cut with a band saw machine for reducing the volume. Among the solid reagent waste, a used adsorbent after the experiments is heated, and an extractant is decomposed for its stabilization. All high level radioactive solid wastes in the hot cells are packed in a high level radioactive solid waste can. The high level radioactive solid waste can is transported to the 2nd High Active Solid Waste Storage in the Tokai Reprocessing Plant in the Japan Atomic Energy Agency.

Keywords: High level radioactive solid waste, advanced reactor fuel reprocessing, radioactive waste disposal, nuclear fuel cycle technology.

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Authors: Hsin-Yun Lee

Abstract:

The previous proposed evacuation routing approaches usually divide the space into multiple interlinked zones. However, it may be harder to clearly and objectively define the margins of each zone. This paper proposes an approach that connects locations of necessary guidance into a spatial network. In doing so, evacuation routes can be constructed based on the links between starting points, turning nodes, and terminal points. This approach more conforms to the real-life evacuation behavior. The feasibility of the proposed approach is evaluated through a case of one floor in a hospital building. Results indicate that the proposed approach provides valuable suggestions for evacuation planning.

Keywords: Evacuation, spatial network, simulation.

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Authors: Teerada Apibunyopas, Nithinant Thammakoranonta

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Many organizations bring e-Learning to use as a tool in their training and human development department. It is getting more popular because it is easy to access to get knowledge all the time and also it provides a rich content, which can develop the employees’ skill efficiently. This study is focused on the factors that affect using e-Learning efficiently, so it will make job satisfaction increasing. The questionnaires were sent to employees in large commercial banks, which use e-Learning located in Bangkok, the results from multiple linear regression analysis showed that employee’s characteristics, characteristics of e-Learning, learning and growth have influence on job satisfaction.

Keywords: e-Learning, Job Satisfaction, Learning and growth.

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Authors: Z. Nurzaireena, K. Azalea, T. Azirawaty, S. Jameela, G. Muralitharan

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The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.

Keywords: Anemia, haemoglobinopathies, pregnancy, sickle cell disease.

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