Links between Inflammation and Insulin Resistance in Children with Morbid Obesity and Metabolic Syndrome

Obesity is a clinical state associated with low-grade inflammation. It is also a major risk factor for insulin resistance (IR). In its advanced stages, metabolic syndrome (MetS), a much more complicated disease which may lead to life-threatening problems, may develop. Obesity-mediated IR seems to correlate with the inflammation. Human studies performed particularly on pediatric population are scarce. The aim of this study is to detect possible associations between inflammation and IR in terms of some related ratios. 549 children were grouped according to their age- and sex-based body mass index (BMI) percentile tables of WHO. MetS components were determined. Informed consent and approval from the Ethics Committee for Clinical Investigations were obtained. The principles of the Declaration of Helsinki were followed. The exclusion criteria were infection, inflammation, chronic diseases and those under drug treatment. Anthropometric measurements were obtained. Complete blood cell, fasting blood glucose, insulin, and C-reactive protein (CRP) analyses were performed. Homeostasis model assessment of insulin resistance (HOMA-IR), systemic immune inflammation (SII) index, tense index, alanine aminotransferase to aspartate aminotransferase ratio (ALT/AST), neutrophils to lymphocyte (NLR), platelet to lymphocyte, and lymphocyte to monocyte ratios were calculated. Data were evaluated by statistical analyses. The degree for statistical significance was 0.05. Statistically significant differences were found among the BMI values of the groups (p < 0.001). Strong correlations were detected between the BMI and waist circumference (WC) values in all groups. Tense index values were also correlated with both BMI and WC values in all groups except overweight (OW) children. SII index values of children with normal BMI were significantly different from the values obtained in OW, obese, morbid obese and MetS groups. Among all the other lymphocyte ratios, NLR exhibited a similar profile. Both HOMA-IR and ALT/AST values displayed an increasing profile from N towards MetS3 group. BMI and WC values were correlated with HOMA-IR and ALT/AST. Both in morbid obese and MetS groups, significant correlations between CRP versus SII index as well as HOMA-IR versus ALT/AST were found. ALT/AST and HOMA-IR values were correlated with NLR in morbid obese group and with SII index in MetS group, (p < 0.05), respectively. In conclusion, these findings showed that some parameters may exhibit informative differences between the early and late stages of obesity. Important associations among HOMA-IR, ALT/AST, NLR and SII index have come to light in the morbid obese and MetS groups. This study introduced the SII index and NLR as important inflammatory markers for the discrimination of normal and obese children. Interesting links were observed between inflammation and IR in morbid obese children and those with MetS, both being late stages of obesity.

Evaluation of the Weight-Based and Fat-Based Indices in Relation to Basal Metabolic Rate-to-Weight Ratio

Basal metabolic rate is questioned as a risk factor for weight gain. The relations between basal metabolic rate and body composition have not been cleared yet. The impact of fat mass on basal metabolic rate is also uncertain. Within this context, indices based upon total body mass as well as total body fat mass are available. In this study, the aim is to investigate the potential clinical utility of these indices in the adult population. 287 individuals, aged from 18 to 79 years, were included into the scope of the study. Based upon body mass index values, 10 underweight, 88 normal, 88 overweight, 81 obese, and 20 morbid obese individuals participated. Anthropometric measurements including height (m), and weight (kg) were performed. Body mass index, diagnostic obesity notation model assessment index I, diagnostic obesity notation model assessment index II, basal metabolic rate-to-weight ratio were calculated. Total body fat mass (kg), fat percent (%), basal metabolic rate, metabolic age, visceral adiposity, fat mass of upper as well as lower extremities and trunk, obesity degree were measured by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical evaluations were performed by statistical package (SPSS) for Windows Version 16.0. Scatterplots of individual measurements for the parameters concerning correlations were drawn. Linear regression lines were displayed. The statistical significance degree was accepted as p < 0.05. The strong correlations between body mass index and diagnostic obesity notation model assessment index I as well as diagnostic obesity notation model assessment index II were obtained (p < 0.001). A much stronger correlation was detected between basal metabolic rate and diagnostic obesity notation model assessment index I in comparison with that calculated for basal metabolic rate and body mass index (p < 0.001). Upon consideration of the associations between basal metabolic rate-to-weight ratio and these three indices, the best association was observed between basal metabolic rate-to-weight and diagnostic obesity notation model assessment index II. In a similar manner, this index was highly correlated with fat percent (p < 0.001). Being independent of the indices, a strong correlation was found between fat percent and basal metabolic rate-to-weight ratio (p < 0.001). Visceral adiposity was much strongly correlated with metabolic age when compared to that with chronological age (p < 0.001). In conclusion, all three indices were associated with metabolic age, but not with chronological age. Diagnostic obesity notation model assessment index II values were highly correlated with body mass index values throughout all ranges starting with underweight going towards morbid obesity. This index is the best in terms of its association with basal metabolic rate-to-weight ratio, which can be interpreted as basal metabolic rate unit.

Understanding the Nature of Blood Pressure as Metabolic Syndrome Component in Children

Pediatric overweight and obesity need attention because they may cause morbid obesity, which may develop metabolic syndrome (MetS). Criteria used for the definition of adult MetS cannot be applied for pediatric MetS. Dynamic physiological changes that occur during childhood and adolescence require the evaluation of each parameter based upon age intervals. The aim of this study is to investigate the distribution of blood pressure (BP) values within diverse pediatric age intervals and the possible use and clinical utility of a recently introduced Diagnostic Obesity Notation Model Assessment Tension (DONMA tense) Index derived from systolic BP (SBP) and diastolic BP (DBP) [SBP+DBP/200]. Such a formula may enable a more integrative picture for the assessment of pediatric obesity and MetS due to the use of both SBP and DBP. 554 children, whose ages were between 6-16 years participated in the study; the study population was divided into two groups based upon their ages. The first group comprises 280 cases aged 6-10 years (72-120 months), while those aged 10-16 years (121-192 months) constituted the second group. The values of SBP, DBP and the formula (SBP+DBP/200) covering both were evaluated. Each group was divided into seven subgroups with varying degrees of obesity and MetS criteria. Two clinical definitions of MetS have been described. These groups were MetS3 (children with three major components), and MetS2 (children with two major components). The other groups were morbid obese (MO), obese (OB), overweight (OW), normal (N) and underweight (UW). The children were included into the groups according to the age- and sex-based body mass index (BMI) percentile values tabulated by WHO. Data were evaluated by SPSS version 16 with p < 0.05 as the statistical significance degree. Tension index was evaluated in the groups above and below 10 years of age. This index differed significantly between N and MetS as well as OW and MetS groups (p = 0.001) above 120 months. However, below 120 months, significant differences existed between MetS3 and MetS2 (p = 0.003) as well as MetS3 and MO (p = 0.001). In comparison with the SBP and DBP values, tension index values have enabled more clear-cut separation between the groups. It has been detected that the tension index was capable of discriminating MetS3 from MetS2 in the group, which was composed of children aged 6-10 years. This was not possible in the older group of children. This index was more informative for the first group. This study also confirmed that 130 mm Hg and 85 mm Hg cut-off points for SBP and DBP, respectively, are too high for serving as MetS criteria in children because the mean value for tension index was calculated as 1.00 among MetS children. This finding has shown that much lower cut-off points must be set for SBP and DBP for the diagnosis of pediatric MetS, especially for children under-10 years of age. This index may be recommended to discriminate MO, MetS2 and MetS3 among the 6-10 years of age group, whose MetS diagnosis is problematic.

Coalescence of Insulin and Triglyceride/High Density Lipoprotein Cholesterol Ratio for the Derivation of a Laboratory Index to Predict Metabolic Syndrome in Morbid Obese Children

Morbid obesity is a health threatening condition particularly in children. Generally, it leads to the development of metabolic syndrome (MetS) characterized by central obesity, elevated fasting blood glucose (FBG), triglyceride (TRG), blood pressure values and suppressed high density lipoprotein cholesterol (HDL-C) levels. However, some ambiguities exist during the diagnosis of MetS in children below 10 years of age. Therefore, clinicians are in the need of some surrogate markers for the laboratory assessment of pediatric MetS. In this study, the aim is to develop an index, which will be more helpful during the evaluation of further risks detected in morbid obese (MO) children. A total of 235 children with normal body mass index (N-BMI), with varying degrees of obesity; overweight (OW), obese (OB), MO as well as MetS participated in this study. The study was approved by the Institutional Ethical Committee. Informed consent forms were obtained from the parents of the children. Obesity states of the children were classified using BMI percentiles adjusted for age and sex. For the purpose, tabulated data prepared by WHO were used. MetS criteria were defined. Systolic and diastolic blood pressure values were measured. Parameters related to glucose and lipid metabolisms were determined. FBG, insulin (INS), HDL-C, TRG concentrations were determined. Diagnostic Obesity Notation Model Assessment Laboratory (DONMALAB) Index [ln TRG/HDL-C*INS] was introduced. Commonly used insulin resistance (IR) indices such as Homeostatic Model Assessment for IR (HOMA-IR) as well as ratios such as TRG/HDL-C, TRG/HDL-C*INS, HDL-C/TRG*INS, TRG/HDL-C*INS/FBG, log, and ln versions of these ratios were calculated. Results were interpreted using statistical package program (SPSS Version 16.0) for Windows. The data were evaluated using appropriate statistical tests. The degree for statistical significance was defined as 0.05. 35 N, 20 OW, 47 OB, 97 MO children and 36 with MetS were investigated. Mean ± SD values of TRG/HDL-C were 1.27 ± 0.69, 1.86 ± 1.08, 2.15 ± 1.22, 2.48 ± 2.35 and 4.61 ± 3.92 for N, OW, OB, MO and MetS children, respectively. Corresponding values for the DONMALAB index were 2.17 ± 1.07, 3.01 ± 0.94, 3.41 ± 0.93, 3.43 ± 1.08 and 4.32 ± 1.00. TRG/HDL-C ratio significantly differed between N and MetS groups. On the other hand, DONMALAB index exhibited statistically significant differences between N and all the other groups except the OW group. This index was capable of discriminating MO children from those with MetS. Statistically significant elevations were detected in MO children with MetS (p < 0.05). Multiple parameters are commonly used during the assessment of MetS. Upon evaluation of the values obtained for N, OW, OB, MO groups and for MO children with MetS, the [ln TRG/HDL-C*INS] value was unique in discriminating children with MetS.

Fabrication and Characterization of Al2O3 Based Electrical Insulation Coatings Around SiC Fibers

In structural-health monitoring of fiber reinforced plastics (FRPs), every single inorganic fiber sensor that are integrated into the bulk material requires an electrical insulation around itself, when the surrounding reinforcing fibers are electrically conductive. This results in a more accurate data acquisition only from the sensor fiber without any electrical interventions. For this purpose, thin nano-films of aluminium oxide (Al2O3)-based electrical-insulation coatings have been fabricated around the Silicon Carbide (SiC) single fiber sensors through reactive DC magnetron sputtering technique. The sputtered coatings were amorphous in nature and the thickness of the coatings increased with an increase in the sputter time. Microstructural characterization of the coated fibers performed using scanning electron microscopy (SEM) confirmed a homogeneous circumferential coating with no detectable defects or cracks on the surface. X-ray diffraction (XRD) analyses of the as-sputtered and 2 hours annealed coatings (825 & 1125 ˚C) revealed the amorphous and crystalline phases of Al2O3 respectively. Raman spectroscopic analyses produced no characteristic bands of Al2O3, as the thickness of the films was in the nanometer (nm) range, which is too small to overcome the actual penetration depth of the laser used. In addition, the influence of the insulation coatings on the mechanical properties of the SiC sensor fibers has been analyzed.

The Effect of Fly Ash in Dewatering of Marble Processing Wastewaters

In the thermal power plants established to meet the energy need, lignite with low calorie and high ash content is used. Burning of these coals results in wastes such as fly ash, slag and flue gas. This constitutes a significant economic and environmental problems. However, fly ash can find evaluation opportunities in various sectors. In this study, the effectiveness of fly ash on suspended solid removal from marble processing wastewater containing high concentration of suspended solids was examined. Experiments were carried out for two different suspensions, marble and travertine. In the experiments, FeCl3, Al2(SO4)3 and anionic polymer A130 were used also to compare with fly ash. Coagulant/flocculant type/dosage, mixing time/speed and pH were the experimental parameters. The performances in the experimental studies were assessed with the change in the interface height during sedimentation resultant and turbidity values of treated water. The highest sedimentation efficiency was achieved with anionic flocculant. However, it was determined that fly ash can be used instead of FeCl3 and Al2(SO4)3 in the travertine plant as a coagulant.

Comparison of Machine Learning Models for the Prediction of System Marginal Price of Greek Energy Market

The Greek Energy Market is structured as a mandatory pool where the producers make their bid offers in day-ahead basis. The System Operator solves an optimization routine aiming at the minimization of the cost of produced electricity. The solution of the optimization problem leads to the calculation of the System Marginal Price (SMP). Accurate forecasts of the SMP can lead to increased profits and more efficient portfolio management from the producer`s perspective. Aim of this study is to provide a comparative analysis of various machine learning models such as artificial neural networks and neuro-fuzzy models for the prediction of the SMP of the Greek market. Machine learning algorithms are favored in predictions problems since they can capture and simulate the volatilities of complex time series.

Feasibility Study of a Solar Farm Project with an Executive Approach

Since 2015, a new approach and policy regarding energy resources protection and using renewable energies has been started in Iran which was developing new projects. Investigating about the feasibility study of these new projects helped to figure out five steps to prepare an executive feasibility study of the concerned projects, which are proper site selections, authorizations, design and simulation, economic study and programming, respectively. The results were interesting and essential for decision makers and investors to start implementing of these projects in reliable condition. The research is obtained through collection and study of the project's documents as well as recalculation to review conformity of the results with GIS data and the technical information of the bidders. In this paper, it is attempted to describe the result of the performed research by describing the five steps as an executive methodology, for preparing a feasible study of installing a 10 MW – solar farm project. The corresponding results of the research also help decision makers to start similar projects is explained in this paper as follows: selecting the best location for the concerned PV plant, reliable and safe conditions for investment and the required authorizations to start implementing the solar farm project in the concerned region, selecting suitable component to achieve the best possible performance for the plant, economic profit of the investment, proper programming to implement the project on time.

Reduced Rule Based Fuzzy Logic Controlled Isolated Bidirectional Converter Operating in Extended Phase Shift Control for Bidirectional Energy Transfer

Bidirectional energy transfer capability with high efficiency and reduced cost is fast gaining prominence in the central part of a lot of power conversion systems in Direct Current (DC) microgrid. Preferably, under the economics constraints, these systems utilise a single high efficiency power electronics conversion system and a dual active bridge converter. In this paper, modeling and performance of Dual Active Bridge (DAB) converter with Extended Phase Shift (EPS) is evaluated with two batteries on both sides of DC bus and bidirectional energy transfer is facilitated and this is further compared with the Single Phase Shift (SPS) mode of operation. Optimum operating zone is identified through exhaustive simulations using MATLAB/Simulink and SimPowerSystem software. Reduced rules based fuzzy logic controller is implemented for closed loop control of DAB converter. The control logic enables the bidirectional energy transfer within the batteries even at lower duty ratios. Charging and discharging of batteries is supervised by the fuzzy logic controller. State of charge, current and voltage for both the batteries are plotted in the battery characteristics. Power characteristics of batteries are also obtained using MATLAB simulations.

Application of Kaftan Cloths from Ottoman Military Period to Nowadays World

Among the Ottomans, dress was one of the means of expression of the society to which an individual was belonged, and as much as the cloth of the dress, its color reflected the individual's class. Those cloths, and the type and color of the dresses that were worn in the court, were forbidden to ordinary people. In addition, whatever the person's position was, his/her clothes were changed according to that special time and position. The clothes that were worn on trips and ceremonies were different from ordinary clothes in everyday life. At the time of the Ottoman Empire and the old Turkey, the miniature forms, and historical manuscripts were an indicator of the time of that day, and each of them is used as a document from the history of that time for today. The method used in this study is descriptive-analytical and the data collection procedure has been done through library. In this article, the cloth, shape and form of the Kaftan is considered. Firstly, a summary of the history and an explanation of this style of dressing and the importance of it at that time are considered. Finally, by the completion of this research, some of the findings of this research are mentioned, such as the distinctive features of this style and the process of updating it to use it in the present era.

Design and Fabrication of a Parabolic Trough Collector and Experimental Investigation of Wind Impact on Direct Steam Production in Tehran

The present paper aims to the techno-economic feasibility of enhancing low-cost parabolic trough collectors in the light of developing the use of solar energy in under-developed regions where expensive high-tech solar devices cannot be afforded. Moreover, the collector is aimed to produce steam so that its performance is based on heat which can be discovered. In this regard, the manufacturing process and the detailed design models in Solidworks software are elaborated. Furthermore, the colletor’s material is chosen in a way to minimize the costs. Finally, to assess the performance of the built collector, it is installed in the site of Shahid Beheshti University, Tehran, and the values of the effective peripheral parameters, such as temperature, wind speed, and most importantly, solar irradiance, are recorded simultaneously in June. According to the results obtained, the manufactured collector with the aperture area of 2 m2 (1×2 m) is capable of producing 350 ml.h-1 steam. Also, the wind influence is comprehensively investigated in this paper. As a case in point, it was measured that as the wind speed maximized to 9.77 km/h, the amount of steam outlet is minimized to 580 ml.

Phytochemical Analysis and Antioxidant Activity of Colocasia esculenta (L.) Leaves

Colocasia esculenta leaves and roots are widely used in Asian countries, such as, India, Srilanka and Pakistan, as food and feed material. The root is high in carbohydrates and rich in zinc. The leaves and stalks are often traditionally preserved to be eaten in dry season. Leaf juice is stimulant, expectorant, astringent, appetizer, and otalgia. Looking at the medicinal uses of the plant leaves; phytochemicals were extracted from the plant leaves and were characterized using Fourier-transform infrared spectroscopy (FTIR) to find the functional groups. Phytochemical analysis of Colocasia esculenta (L.) leaf was studied using three solvents (methanol, chloroform, and ethanol) with soxhlet apparatus. Powder of the leaves was employed to obtain the extracts, which was qualitatively and quantitatively analyzed for phytochemical content using standard methods. Phytochemical constituents were abundant in the leave extract. Leaf was found to have various phytochemicals such as alkaloids, glycosides, flavonoids, terpenoids, saponins, oxalates and phenols etc., which could have lot of medicinal benefits such as reducing headache, treatment of congestive heart failure, prevent oxidative cell damage etc. These phytochemicals were identified using UV spectrophotometer and results were presented. In order to find the antioxidant activity of the extract, DPPH (2,2-diphenyl-1-picrylhydrazyl) method was employed using ascorbic acid as standard. DPPH scavenging activity of ascorbic acid was found to be 84%, whereas for ethanol it was observed to be 78.92%, for methanol: 76.46% and for chloroform: 72.46%. Looking at the high antioxidant activity, Colocasia esculenta may be recommended for medicinal applications. The characterizations of functional groups were analyzed using FTIR spectroscopy.

Bidirectional Pendulum Vibration Absorbers with Homogeneous Variable Tangential Friction: Modelling and Design

Passive resonant vibration absorbers are among the most widely used dynamic control systems in civil engineering. They typically consist in a single-degree-of-freedom mechanical appendage of the main structure, tuned to one structural target mode through frequency and damping optimization. One classical scheme is the pendulum absorber, whose mass is constrained to move along a curved trajectory and is damped by viscous dashpots. Even though the principle is well known, the search for improved arrangements is still under way. In recent years this investigation inspired a type of bidirectional pendulum absorber (BPA), consisting of a mass constrained to move along an optimal three-dimensional (3D) concave surface. For such a BPA, the surface principal curvatures are designed to ensure a bidirectional tuning of the absorber to both principal modes of the main structure, while damping is produced either by horizontal viscous dashpots or by vertical friction dashpots, connecting the BPA to the main structure. In this paper, a variant of BPA is proposed, where damping originates from the variable tangential friction force which develops between the pendulum mass and the 3D surface as a result of a spatially-varying friction coefficient pattern. Namely, a friction coefficient is proposed that varies along the pendulum surface in proportion to the modulus of the 3D surface gradient. With such an assumption, the dissipative model of the absorber can be proven to be nonlinear homogeneous in the small displacement domain. The resulting homogeneous BPA (HBPA) has a fundamental advantage over conventional friction-type absorbers, because its equivalent damping ratio results independent on the amplitude of oscillations, and therefore its optimal performance does not depend on the excitation level. On the other hand, the HBPA is more compact than viscously damped BPAs because it does not need the installation of dampers. This paper presents the analytical model of the HBPA and an optimal methodology for its design. Numerical simulations of single- and multi-story building structures under wind and earthquake loads are presented to compare the HBPA with classical viscously damped BPAs. It is shown that the HBPA is a promising alternative to existing BPA types and that homogeneous tangential friction is an effective means to realize systems provided with amplitude-independent damping.

Characterization of Aluminium Alloy 6063 Hybrid Metal Matrix Composite by Using Stir Casting Method

The present research is a paper on the characterization of aluminum alloy-6063 hybrid metal matrix composites using three different reinforcement materials (SiC, red mud, and fly ash) through stir casting method. The red mud was used in solid form, and particle size range varies between 103-150 µm. During this investigation, fly ash is received from Guru Nanak Dev Thermal Plant (GNDTP), Bathinda. The study has been done by using Taguchi’s L9 orthogonal array by taking fraction wt.% (SiC 5%, 7.5%, and 10% and Red Mud and Fly Ash 2%, 4%, and 6%) as input parameters with their respective levels. The study of the mechanical properties (tensile strength, impact strength, and microhardness) has been done by using Analysis of Variance (ANOVA) with the help of MINITAB 17 software. It is revealed that silicon carbide is the most significant parameter followed by red mud and fly ash affecting the mechanical properties, respectively. The fractured surface morphology of the composites using Field Emission Scanning Electron Microscope (FESEM) shows that there is a good mixing of reinforcement particles in the matrix. Energy-dispersive X-ray spectroscopy (EDS) was performed to know the presence of the phases of the reinforced material.

Evaluation of the Performance of ACTIFLO® Clarifier in the Treatment of Mining Wastewaters: Case Study of Costerfield Mining Operations, Victoria, Australia

A pre-treatment stage prior to reverse osmosis (RO) is very important to ensure the long-term performance of the RO membranes in any wastewater treatment using RO. This study aims to evaluate the application of the Actiflo® clarifier as part of a pre-treatment unit in mining operations. It involves performing analytical testing on RO feed water before and after installation of Actiflo® unit. Water samples prior to RO plant stage were obtained on different dates from Costerfield mining operations in Victoria, Australia. Tests were conducted in an independent laboratory to determine the concentration of various compounds in RO feed water before and after installation of Actiflo® unit during the entire evaluated period from December 2015 to June 2018. Water quality analysis shows that the quality of RO feed water has remarkably improved since installation of Actiflo® clarifier. Suspended solids (SS) and turbidity removal efficiencies has been improved by 91 and 85 percent respectively in pre-treatment system since the installation of Actiflo®. The Actiflo® clarifier proved to be a valuable part of pre-treatment system prior to RO. It has the potential to conveniently condition the mining wastewater prior to RO unit, and reduce the risk of RO physical failure and irreversible fouling. Consequently, reliable and durable operation of RO unit with minimum requirement for RO membrane replacement is expected with Actiflo® in use.

Antibiotic Prescribing in the Acute Care in Iraq

Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Assessment of Socio-Cultural Sustainability: A Comparative Analysis of Two Neighborhoods in Kolkata Metropolitan Area

To transform a space into a better livable and sustainable zone, United Nations Summit in New York 2015, has decided upon 17 sustainable development goals (SDGs) that approach directly to achieve inclusive, people-centric, sustainable developments. Though sustainability has been majorly constructed by four pillars, namely, Ecological, Economic, Social and Cultural, but it is essentially reduced to economic and ecological consideration in the context of developing countries. Therefore, in most cases planning has reduced its ambit to concentrate around the tangible infrastructure, ignoring the fundamentals of socio-cultural heritage. With the accentuating hype of infrastructural augmentation, lack of emphasis of traditional concerns like ethnicity and social connection have further diluted the situation, disintegrating cultural continuity. As cultural continuity lacks its cohesion, it’s growing absence increasingly acts as a catalyst to degrade the heritage structures, spaces around and linking these structures, and the ability of stakeholders in identifying themselves rooted in that particular space. Hence, this paper will argue that sustainability depends on the people and their interaction with their surroundings, their culture and livelihood. The interaction between people and their surroundings strengthen community building and social interaction that abides by stakeholders reverting back to their roots. To assess the socio-cultural sustainability of the city of Kolkata, two study areas are selected, namely, an old settlement from the northern part of the city of Kolkata (KMA), imbued with social connection, age-old cultural and ethnic bonding and, another cluster of new high-rises coming up in the Newtown area having portions of planned city extension on the eastern side of the city itself. Whereas, Newtown prioritizes the surging post-industrial trends of economic aspiration and ecological aspects of urban sustainability; the former settlements of northern Kolkata still continue to represent the earliest community settlement of the British-colonial-cum native era and even the pre-colonial era, permeated with socio-cultural reciprocation. Thus, to compare and assess the inlayed organizational structure of both the spaces in the two cases, selected areas have been surveyed to portray their current imageability. The argument of this paper is structured in 5parts. First, an introduction of the idea has been forwarded, Secondly, a literature review has been conducted to ground the proposed ideas, Thirdly, methodology has been discussed and appropriate case study areas have been selected, Fourthly, surveys and analyses has been forwarded and lastly, the paper has arrived at a set of conclusions by suggesting a threefold development to create happy, healthy and sustainable community.

JENOSYS: Application of a Web-Based Online Energy Performance Reporting Tool for Government Buildings in Malaysia

One of the areas that present an opportunity to reduce the national carbon emission is the energy management of public buildings. To our present knowledge, there is no easy-to-use and centralized mechanism that enables the government to monitor the overall energy performance, as well as the carbon footprint, of Malaysia’s public buildings. Therefore, the Public Works Department Malaysia, or PWD, has developed a web-based energy performance reporting tool called JENOSYS (JKR Energy Online System), which incorporates a database of utility account numbers acquired from the utility service provider for analysis and reporting. For test case purposes, 23 buildings under PWD were selected and monitored for their monthly energy performance (in kWh), carbon emission reduction (in tCO₂eq) and utility cost (in MYR), against the baseline. This paper demonstrates the simplicity with which buildings without energy metering can be monitored centrally and the benefits that can be accrued by the government in terms of building energy disclosure and concludes with the recommendation of expanding the system to all the public buildings in Malaysia.

A Multi-Objective Methodology for Selecting Lean Initiatives in Modular Construction Companies

The implementation of lean manufacturing initiatives has produced significant impacts in improving operational performance and reducing manufacturing wastes in the production process. However, selecting an appropriate set of lean strategies is critical to avoid misapplication of the lean manufacturing techniques and consequential increase in non-value-adding activities. To the author’s best knowledge, there is currently no methodology to select lean strategies that considers their impacts on manufacturing wastes and performance metrics simultaneously. In this research, a multi-objective methodology is proposed that suggests an appropriate set of lean initiatives based on their impacts on performance metrics and manufacturing wastes and within manufacturers’ resource limitation. The proposed methodology in this research suggests the best set of lean initiatives for implementation that have highest impacts on identified critical performance metrics and manufacturing wastes. Therefore, manufacturers can assure that implementing suggested lean tools improves their production performance and reduces manufacturing wastes at the same time. A case study was conducted to show the effectiveness and validate the proposed model and methodologies.

Pilot Induced Oscillations Adaptive Suppression in Fly-By-Wire Systems

The present work proposes the development of an adaptive control system which enables the suppression of Pilot Induced Oscillations (PIO) in Digital Fly-By-Wire (DFBW) aircrafts. The proposed system consists of a Modified Model Reference Adaptive Control (M-MRAC) integrated with the Gain Scheduling technique. The PIO oscillations are detected using a Real Time Oscillation Verifier (ROVER) algorithm, which then enables the system to switch between two reference models; one in PIO condition, with low proneness to the phenomenon and another one in normal condition, with high (or medium) proneness. The reference models are defined in a closed loop condition using the Linear Quadratic Regulator (LQR) control methodology for Multiple-Input-Multiple-Output (MIMO) systems. The implemented algorithms are simulated in software implementations with state space models and commercial flight simulators as the controlled elements and with pilot dynamics models. A sequence of pitch angles is considered as the reference signal, named as Synthetic Task (Syntask), which must be tracked by the pilot models. The initial outcomes show that the proposed system can detect and suppress (or mitigate) the PIO oscillations in real time before it reaches high amplitudes.