What are the levels of customer satisfaction within the waste disposal industry.

Thesis (MBA)-University of Natal, Durban, 2003.South Africa's re-integration into the global economy and the international political arena has brought about an active growth of business locally and internationally. Local companies are expanding into new markets and regions which require them to follow internationally acceptable and approved waste disposal policies in their production of goods and services. To achieve compliance, it is necessary that companies have the appropriate support and backup from waste disposal companies. Also, increasing pressure from environmental groups and government agencies makes it a prerequisite that a company's waste is properly disposed of in the most efficient, lawful and economical way. This research dissertation is aimed at identifying the key factors that impact on the levels of service in the waste industry and an attempt at evaluating the effects of the service levels to determine what actions are necessary to improve the levels of service in the waste industry. As a result, this research was carried out amongst producers of waste in certain areas of KwaZulu-Natal. Various techniques were evaluated in researching how to measure service quality. The most reliable measuring instrument to gauge service quality was found to be the SERVQUAL system. This measuring instrument was evaluated and then modified to suit the particular needs of the waste industry. The SERVQUAL system is a multi-item scale for measuring consumers perceptions of service quality. A sample of 75 companies was selected and senior management was interviewed. Based on the statistical analysis, the discrepancy between service expectations and service delivery in the waste industry is wide. Urgent attention needs to be focused on service delivery, especially reliability, assurance and responsiveness by waste disposal companies

Large parathyroid adenomas: Potential mechanisms to reconcile adenoma size and disease phenotype

Parathyroid adenomas weighing more than 3.5 g are reported variously as atypical , large or giant parathyroid adenomas. All such adenomas are rare variants accounting for no more than 1.5% of all parathyroid adenomas. Large parathyroid adenomas are often associated with more severe form of the disease, including osteitis fibrosa cystica (OFC) and share many biochemical, histological, and molecular features of both benign and malignant parathyroid neoplasms, and are considered a distinct clinical entity. However, the pathogenesis of oversized parathyroid adenomas and the often-associated skeletal phenotype remains unclear. We present 5 cases of primary hyperparathyroidism (PHPT) with OFC, an uncommon manifestation of contemporary PHPT, associated with larger parathyroid adenomas, seen in the Bone and Mineral Disorders Clinic of the Henry Ford Health in the last 30 years to illustrate the critical role of vitamin D nutrition in the pathogenesis of both the OFC and adenoma size. The estimated prevalence of OFC was very low 0.2%, 5 of the \u3e3000 surgically confirmed cases of PHPT seen during this time. The mean ± SD values were: age: 36.8 ± 22.1 years (4 of the 510 years of follow-up. Because OFC is a very rare in the West, but very common areas of endemic vitamin D deficiency, we also examined the relationship between vitamin D nutrition, as assessed by serum 25-hydroxyvitamin D level, and parathyroid adenoma weight as well as prevalence of OFC in two large secularly diverse cohorts of patients with PHPT (Detroit, USA and Chandigarh, India). Based on this relationship and the relative prevalence of OFC in these two large cohorts, we propose that vitamin D nutrition (and perhaps calcium nutrition) best explains both the adenoma size and prevalence of OFC

Age-dependent and sex-dependent disparity in mortality in patients with adrenal incidentalomas and autonomous cortisol secretion: an international, retrospective, cohort study

Background: The association between cortisol secretion and mortality in patients with adrenal incidentalomas is controversial. We aimed to assess all-cause mortality, prevalence of comorbidities, and occurrence of cardiovascular events in uniformly stratified patients with adrenal incidentalomas and cortisol autonomy (defined as non-suppressible serum cortisol on dexamethasone suppression testing). Methods: We conducted an international, retrospective, cohort study (NAPACA Outcome) at 30 centres in 16 countries. Eligible patients were aged 18 years or older with an adrenal incidentaloma (diameter ≥1 cm) detected between Jan 1, 1996, and Dec 31, 2015, and availability of a 1 mg dexamethasone suppression test result from the time of the initial diagnosis. Patients with clinically apparent hormone excess, active malignancy, or follow-up of less than 36 months were excluded. Patients were stratified according to the 0800–0900 h serum cortisol values after an overnight 1 mg dexamethasone suppression test; less than 50 nmol/L was classed as non-functioning adenoma, 50–138 nmol/L as possible autonomous cortisol secretion, and greater than 138 nmol/L as autonomous cortisol secretion. The primary endpoint was all-cause mortality. Secondary endpoints were the prevalence of cardiometabolic comorbidities, cardiovascular events, and cause-specific mortality. The primary and secondary endpoints were assessed in all study participants. Findings: Of 4374 potentially eligible patients, 3656 (2089 [57·1%] with non-functioning adenoma, 1320 [36·1%] with possible autonomous cortisol secretion, and 247 [6·8%] with autonomous cortisol secretion) were included in the study cohort for mortality analysis (2350 [64·3%] women and 1306 [35·7%] men; median age 61 years [IQR 53–68]; median follow-up 7·0 years [IQR 4·7–10·2]). During follow-up, 352 (9·6%) patients died. All-cause mortality (adjusted for age, sex, comorbidities, and previous cardiovascular events) was significantly increased in patients with possible autonomous cortisol secretion (HR 1·52, 95% CI 1·19–1·94) and autonomous cortisol secretion (1·77, 1·20–2·62) compared with patients with non-functioning adenoma. In women younger than 65 years, autonomous cortisol secretion was associated with higher all-cause mortality than non-functioning adenoma (HR 4·39, 95% CI 1·93–9·96), although this was not observed in men. Cardiometabolic comorbidities were significantly less frequent with non-functioning adenoma than with possible autonomous cortisol secretion and autonomous cortisol secretion (hypertension occurred in 1186 [58·6%] of 2024 patients with non-functioning adenoma, 944 [74·0%] of 1275 with possible autonomous cortisol secretion, and 179 [75·2%] of 238 with autonomous cortisol secretion; dyslipidaemia occurred in 724 [36·2%] of 1999 patients, 547 [43·8%] of 1250, and 123 [51·9%] of 237; and any diabetes occurred in 365 [18·2%] of 2002, 288 [23·0%] of 1250, and 62 [26·7%] of 232; all p values <0·001). Interpretation: Cortisol autonomy is associated with increased all-cause mortality, particularly in women younger than 65 years. However, until results from randomised interventional trials are available, a conservative therapeutic approach seems to be justified in most patients with adrenal incidentaloma. Funding: Deutsche Forschungsgemeinschaft, Associazione Italiana per la Ricerca sul Cancro, Università di Torino

Techno-economic assessment of scale-up of bio-flocculant extraction and production by using okra as biomass feedstock

This paper reports a techno-economic assessment for industrial scale bio-flocculant production with okra as biomass feedstock. The sludge dewatering ability of the bio-flocculant was evaluated prior to economic analysis. Several optimisation strategies were investigated in order to lower the bio-flocculant production cost. The results showed that continuous mode microwave extraction was more economically beneficial than conventional extraction in batch and continuous modes. Sensitivity analysis revealed that the production cost was significantly affected by annual production and extract yield, and moderately influenced by raw material price. The optimised scheme for bio-flocculant production was continuous mode microwave extraction at 90° C, a residence time of 10 minutes, a water loading of 3.5 w/w and production rate of 220 tonnes per year. The economic assessment showed that the gross margin was positive, return on investment was in the expected range of 20 to 30% and payback time was within 5 years

Nanoimprinting of nanostructured catalysts

One dimensional nanostructured catalyst made of tin and silver has proven to be more effective in the CO2 reduction. The increase in effectiveness is due to the extremely large surface area for catalytic reactions to take place and their curved internal surface that helps to generate a numerous number of highly reactive sites for the CO2 conversion. As such, a lot of time and effort has been spent on discovering possible methodologies for fabricating one-dimensional nano-structures, such as nanowires and nanotubes, in a rapid and efficient manner. This report explores the possibility of using ultrasonic embossing machine as a potential fabrication process for nano-wire production. Ultrasonic embossing is a fabrication technique that uses high frequency ultrasonic energy to replicate mold features on to various substrates. The high frequency ultrasonic energy creates low amplitude mechanical vibrations, which is used to generate friction between the contact area of the mold features and the substrate. The frictional heat melts the substrate, allowing it to conform to the protruding features of the mold, hence forming the required patterns. To achieve a high-quality replication of the mold features onto the substrate, appropriate parameters such as time, amplitude and force. This report will find the best relationship between the ultrasonic embossing parameters to attain the best quality of the nanowires embossed on the substrate. The results show that with the appropriate selection of the parameters, ultrasonic vibration embossing is a viable technique to fabricate nanowires on sliver and tin substratesBachelor of Engineering (Mechanical Engineering

Simulation of closed loop controlled boost converter for solar installation

With the shortage of the energy and ever increasing of the oil price, research on the renewable and green energy sources, especially the solar arrays and the fuel cells, becomes more and more important. How to achieve high stepup and high efficiency DC/DC converters is the major consideration in the renewable power applications due to the low voltage of PV arrays and fuel cells. In this paper digital simulation of closed loop controlled boost converter for solar installation is presented. Circuit models for open loop and closed loop controlled systems are developed using the blocks of simulink. The simulation results are compared with the theoretical results. This converter has advantages like improved power factor, fast response and reduced hardware.

Care Seeking Behaviour and Barriers to Accessing Services for Sexual Health Problems among Women in Rural Areas of Tamilnadu State in India

Background. Sexually transmitted infections (STIs) may be either asymptomatic or symptomatic. Regardless of the presence or absence of symptoms all STIs can lead to major complications if left untreated. Objective. To assess the care seeking behaviour and barriers to accessing services for sexual health problems among young married women in rural areas of Thiruvarur district of Tamil Nadu state in India. Methods. A community based cross-sectional study was conducted in 28 villages selected using multistage sampling technique for selecting 605 women in the age group of 15–24 years during July 2010–April 2011. Results. The prevalence rate of reproductive tract infections (RTIs) and STIs was observed to be 14.5% and 8.8%, respectively, among the study population. Itching/irritation over vulva, thick white discharge, discharge with unpleasant odor, and frequent and uncomfortable urination were most commonly experienced symptoms of sexual health problems. Around three-fourth of the women received treatment for sexual health problems. Perception of symptoms as normal, feeling shy, lack of female health workers, distance to health facility, and lack of availability of treatment were identified as major barriers for not seeking treatment for RTIs/STIs. Conclusion. Family tradition and poor socioeconomic conditions of the family appear to be the main reasons for not utilizing the health facility for sexual health problems. Integrated approach is strongly suggested for creating awareness to control the spread of sexual health problems among young people

Steroid profiling in the diagnosis of mild and overt Cushing\u27s syndrome

In this review, we provide a comprehensive overview of the utility of steroid profiling for diagnosis of management of overt Cushing syndrome and mild autonomous cortisol secretion. A diagnosis of Cushing syndrome is made through a multistep process that includes confirmation of endogenous hypercortisolism, followed by determination of its cause. Steroid metabolomic testing applied to serum or urine steroids and their metabolites can provide additional and novel insights into alterations of steroid biosynthesis and metabolism and its causes. In particular, increased availability and advances in mass spectrometry-based steroid analysis, coupled with machine learning-based algorithms, have facilitated the development of tailored diagnostic and subtyping approaches for autonomous cortisol secretion and might be useful for detecting low grade autonomous glucocorticoid secretion and in predicting and monitoring of disease severity and associated comorbidities

Modelling and optimisation of tongkat ali water extract production utilising a batch process simulator

Eurycoma longifolia or Tongkat Ali water extract is a valued product in the phytochemical industry. This work features the modelling and optimisation of a Tongkat Ali water extract production using SuperPro Designer®, a batch process simulator. The objective of this work is to design an economically viable production scheme for a locally developed Tongkat Ali extract production process. The current pilot scale production scheme of Tongkat Ali extract was used to simulate the base case process. Four alternative production schemes were further developed with several debottlenecking and optimisation strategies. The final alternative scheme was reported to achieve a product yield of 3.00%, with an annual production of 1137.72 kg of Tongkat Ali extract. The minimum batch cycle time was reduced from 24.4 hours in the base case to 8.04 hours. Economic analysis determined that the proposed alternative production scheme has an annual revenue of $6.32M, with a 38.6% gross margin and a 32.9% return on investment

Modelling and optimization of Eurycoma longifolia water extract production

Eurycoma longifolia or Tongkat Ali water extract is a valued product in the phytochemical industry. This work features the modelling and optimization of a Tongkat Ali water extract production using SuperPro Designer®, a commercial batch process simulator. The objective of this work is to design an economically viable production scheme for a locally developed Tongkat Ali extract production process. The current pilot scale production scheme with an annual production rate of 390 kg of Tongkat Ali extract was used to simulate the base case process. Four alternative production schemes were further developed with several debottlenecking and optimization strategies. The final alternative scheme was reported to achieve a product yield of 3.00%, with an annual production of 1137.72 kg of Tongkat Ali extract. The minimum batch cycle time was reduced from 24.44 h in the base case to 8.32 h. Economic analysis determined that the proposed alternative production scheme has an annual revenue of $6.32M, with a 86% gross margin and a 55% return on investment (ROI). The payback period of this scheme was estimated to be less than two years