Search results for: depression anxiety and stress scale of Lovibond
Commenced in January 2007
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Paper Count: 10354

Search results for: depression anxiety and stress scale of Lovibond

7384 Influential Factors Impacting the Utilization of Pain Assessment Tools among Hospitalized Elderly Patients in Taiwan

Authors: Huei Jiun Chen, Hui Mei Huan

Abstract:

Introduction: Pain is an unpleasant experience for hospitalized patients that impacts both their physical and mental well-being. It is important to select appropriate pain assessment tools to ensure effective pain management. Therefore, it is suggested to use Verbal Rating Scale (VRS) instead for better assessment. The Wong-Baker FACES Pain Rating Scale(WBS) is a widely used pain assessment tool in Taiwan to help individuals communicate the intensity of their pain. However, in clinical practice, even when using various assessment tools to evaluate pain, Numeric Rating Scale-11 (NRS-11) is still commonly utilized to quantify the intensity of pain. The correlation between NRS and other pain assessment tools has not been extensively explored in Taiwan. Additionally, the influence of gender and education level on pain assessment among elderly individuals has not been extensively studied in Taiwan. The aim of this study is to investigate the correlation between pain assessment scales (NRS-11, VRS, WBS) in assessing pain intensity among elderly inpatients. The secondary objective of this study is to examine how gender and education level influence pain assessment among individuals, as well as to explore their preferences regarding pain assessment tools. Method: In this study, a questionnaire survey and purposive sampling were employed to recruit participants from a medical center located in central Taiwan. Participants were requested to assess their pain intensity in the past 24 hours using NRS-11, VRS, and WBS. Additionally, the study investigated their preferences for pain assessment tools. Result: A total of 252 participants were included in this study, with a mean age of 71.1 years (SD=6.2). Of these participants, 135 were male (53.6%), and 44.4% had a primary level or below education. Participants were asked to use NRS-11, VRS, and WBS to assess their current, maximum, and minimum pain intensity experienced in the past 24 hours. The findings indicated a significant correlation (p< .01) among all three pain assessment tools. No significant differences were observed in gender across the three pain assessment scales. For severe pain, there were significant differences in self-rated pain scales among the elderly participants with different education levels (F=3.08, p< .01; X²=17.25, X²=17.21, p< .01), but there were no significant differences observed for mild pain. Regarding preferences for pain assessment tools, 158 participants (62.7%) favored VRS, followed by WBS; gender and education level had no influence on their preferences. Conclusion: Most elderly participants prefer using VRS (Verbal Rating Scale) to self-reported their pain. The reason for this preference may be attributed to the verbal nature of VRS, as it is simple and easy to understand. Furthermore, it could be associated with the level of education among the elderly participants. The pain assessment using VRS demonstrated a significant correlation with NRS-11 and WBS, and gender was not found to have any influence on these assessment. Further research is needed to explore the effect of different education levels on self-reported pain intensity among elderly people in Taiwan.

Keywords: pain assessment, elderly, gender, education

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7383 Fertility Transition in Sub-Saharan Africa: The Role Family Planning Programs

Authors: Vincent Otieno, Alfred Agwanda, Anne Khasakhala

Abstract:

Among the neo-Malthusian adherents, it is believed that rapid population growth strain countries’ capacity and performance. Fertility have however decelerated in most of the countries in the recent past. Scholars have concentrated on wide range of factors associated with fertility majorly at the national scale with some opining that analysis of trends and differentials in the various fertility parameters have been discussed extensively. However, others believe that considerably less attention has been paid to the fertility preference- a pathway through which various variables act on fertility. The Sub-Saharan African countries’ disparities amid almost similarities in policies is a cause of concern to demographers. One would point at the meager synergies that have been focused on the fertility preference as well, especially at the macro scale. Using Bongaarts reformulation of Easterlin and Crimmins (1985) conceptual scheme, the understanding of the current transition based on the fertility preference in general would help to provide explanations to the observed latest dynamics. This study therefore is an attempt to explain the current fertility transition through women’s fertility preference. Results reveal that indeed fertility transition is on course in most of the sub-Saharan countries with huge disparities in fertility preferences and its implementation indices.

Keywords: fertility preference, the degree of implementation index, sub-Saharan Africa, transition

Procedia PDF Downloads 243
7382 Providing Health Promotion Information by Digital Animation to International Visitors in Japan: A Factorial Design View of Nurses

Authors: Mariko Nishikawa, Masaaki Yamanaka, Ayami Kondo

Abstract:

Background: International visitors to Japan are at a risk of travel-related illnesses or injury that could result in hospitalization in a country where the language and customs are unique. Over twelve million international visitors came to Japan in 2015, and more are expected leading up to the Tokyo Olympics. One aspect of this is the potentially greater demand on healthcare services by foreign visitors. Nurses who take care of them have anxieties and concerns of their knowledge of the Japanese health system. Objectives: An effective distribution of travel-health information is vital for facilitating care for international visitors. Our research investigates whether a four-minute digital animation (Mari Info Japan), designed and developed by the authors and applied to a survey of 513 nurses who take care of foreigners daily, could clarify travel health procedures, reduce anxieties, while making it enjoyable to learn. Methodology: Respondents to a survey were divided into two groups. The intervention group watched Mari Info Japan. The control group read a standard guidebook. The participants were requested to fill a two-page questionnaire called Mari Meter-X, STAI-Y in English and mark a face scale, before and after the interventions. The questions dealt with knowledge of health promotion, the Japanese healthcare system, cultural concerns, anxieties, and attitudes in Japan. Data were collected from an intervention group (n=83) and control group (n=83) of nurses in a hospital, Japan for foreigners from February to March, 2016. We analyzed the data using Text Mining Studio for open-ended questions and JMP for statistical significance. Results: We found that the intervention group displayed more confidence and less anxiety to take care of foreign patients compared to the control group. The intervention group indicated a greater comfort after watching the animation. However, both groups were most likely to be concerned about language, the cost of medical expenses, informed consent, and choice of hospital. Conclusions: From the viewpoint of nurses, the provision of travel-health information by digital animation to international visitors to Japan was more effective than traditional methods as it helped them be better prepared to treat travel-related diseases and injury among international visitors. This study was registered number UMIN000020867. Funding: Grant–in-Aid for Challenging Exploratory Research 2010-2012 & 2014-16, Japanese Government.

Keywords: digital animation, health promotion, international visitor, Japan, nurse

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7381 Effect of Hydraulic Residence Time on Aromatic Petrochemical Wastewater Treatment Using Pilot-Scale Submerged Membrane Bioreactor

Authors: Fatemeh Yousefi, Narges Fallah, Mohsen Kian, Mehrzad Pakzadeh

Abstract:

The petrochemical complex releases wastewater, which is rich in organic pollutants and could not be treated easily. Treatment of the wastewater from a petrochemical industry has been investigated using a submerged membrane bioreactor (MBR). For this purpose, a pilot-scale submerged MBR with a flat-sheet ultrafiltration membrane was used for treatment of petrochemical wastewater according to Bandar Imam Petrochemical complex (BIPC) Aromatic plant. The testing system ran continuously (24-h) over 6 months. Trials on different membrane fluxes and hydraulic retention time (HRT) were conducted and the performance evaluation of the system was done. During the 167 days operation of the MBR at hydraulic retention time (HRT) of 18, 12, 6, and 3 and at an infinite sludge retention time (SRT), the MBR effluent quality consistently met the requirement for discharge to the environment. A fluxes of 6.51 and 13.02 L m-2 h-1 (LMH) was sustainable and HRT of 6 and 12 h corresponding to these fluxes were applicable. Membrane permeability could be fully recovered after cleaning. In addition, there was no foaming issue in the process. It was concluded that it was feasible to treat the wastewater using submersed MBR technology.

Keywords: membrane bioreactor (MBR), petrochemical wastewater, COD removal, biological treatment

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7380 High Temperature Behaviour of Various Limestone Used in Heritage Buildings at Material and Block Scales

Authors: Ayoub Daoudi, Javad Eslami, Anne-Lise Beaucour, Martin Vigroux, Albert Noumowé

Abstract:

As a fact, many cultural heritage masonry buildings have undergone violent fires during their history. In order to investigate the high temperature behaviour of stone masonry, six French limestones were heated to 600 °C at a rate of 9 °C/min. The main focus is the comparison between the high temperature behaviour of stones at the material and at the structural scale. In order to evaluate the risk of spalling, the tests have been carried out on the stone blocks (12x30x30 cm) instrumented with thermocouples and subjected to an unidirectional heating on one face. Thereafter, visual assessments and non-destructive measurements (dynamic elastic modulus) performed on blocks demonstrate a different behaviour from what was observed at the material scale. Finally, a series of thermo-mechanical computations, using finite element method, allowed us to highlight the difference between the behaviour of stones at material and block scales.

Keywords: limestones, hight temperature behaviour, damage, thermo-mechanical modeling, material and blocks scales, color change

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7379 Effects of Preparation Conditions on the Properties of Crumb Rubber Modified Binder

Authors: Baha Vural Kök, Mehmet Yilmaz, Mustafa Akpolat, Cihat Sav

Abstract:

Various types of additives are used frequently in order to improve the rheological and mechanical properties of bituminous mixtures. Small devices instead of full scale machines are used for bitumen modification in the laboratory. These laboratory scale devices vary in terms of their properties such as mixing rate, mixing blade and the amount of binder. In this study, the effect of mixing rate and time during the bitumen modification processes on conventional and rheological properties of pure and crumb rubber modified binder were investigated. Penetration, softening point, rotational viscosity (RV) and dynamic shear rheometer (DSR) tests were applied to pure and CR modified bitumen. It was concluded that the penetration and softening point test did not show the efficiency of CR obtained by different mixing conditions. Besides, oxidation that occurred during the preparation processes plays a great part in the improvement effects of the modified binder.

Keywords: bitumen, crumb rubber, modification, rheological properties

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7378 Prediction of Boundary Shear Stress with Gradually Tapering Flood Plains

Authors: Spandan Sahu, Amiya Kumar Pati, Kishanjit Kumar Khatua

Abstract:

River is the main source of water. It is a form of natural open channel which gives rise to many complex phenomenon of sciences that needs to be tackled such as the critical flow conditions, boundary shear stress and depth averaged velocity. The development of society more or less solely depends upon the flow of rivers. The rivers are major sources of many sediments and specific ingredients which are much essential for human beings. During floods, part of a river is carried by the simple main channel and rest is carried by flood plains. For such compound asymmetric channels, the flow structure becomes complicated due to momentum exchange between main channel and adjoining flood plains. Distribution of boundary shear in subsections provides us with the concept of momentum transfer between the interface of main channel and the flood plains. Experimentally, to get better data with accurate results are very complex because of the complexity of the problem. Hence, Conveyance Estimation System (CES) software has been used to tackle the complex processes to determine the shear stresses at different sections of an open channel having asymmetric flood plains on both sides of the main channel and the results are compared with the symmetric flood plains for various geometrical shapes and flow conditions. Error analysis is also performed to know the degree of accuracy of the model implemented.

Keywords: depth average velocity, non prismatic compound channel, relative flow depth , velocity distribution

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7377 A Stepwise Approach for Piezoresistive Microcantilever Biosensor Optimization

Authors: Amal E. Ahmed, Levent Trabzon

Abstract:

Due to the low concentration of the analytes in biological samples, the use of Biological Microelectromechanical System (Bio-MEMS) biosensors for biomolecules detection results in a minuscule output signal that is not good enough for practical applications. In response to this, a need has arisen for an optimized biosensor capable of giving high output signal in response the detection of few analytes in the sample; the ultimate goal is being able to convert the attachment of a single biomolecule into a measurable quantity. For this purpose, MEMS microcantilevers based biosensors emerged as a promising sensing solution because it is simple, cheap, very sensitive and more importantly does not need analytes optical labeling (Label-free). Among the different microcantilever transducing techniques, piezoresistive based microcantilever biosensors became more prominent because it works well in liquid environments and has an integrated readout system. However, the design of piezoresistive microcantilevers is not a straightforward problem due to coupling between the design parameters, constraints, process conditions, and performance. It was found that the parameters that can be optimized to enhance the sensitivity of Piezoresistive microcantilever-based sensors are: cantilever dimensions, cantilever material, cantilever shape, piezoresistor material, piezoresistor doping level, piezoresistor dimensions, piezoresistor position, Stress Concentration Region's (SCR) shape and position. After a systematic analyzation of the effect of each design and process parameters on the sensitivity, a step-wise optimization approach was developed in which almost all these parameters were variated one at each step while fixing the others to get the maximum possible sensitivity at the end. At each step, the goal was to optimize the parameter in a way that it maximizes and concentrates the stress in the piezoresistor region for the same applied force thus get the higher sensitivity. Using this approach, an optimized sensor that has 73.5x times higher electrical sensitivity (ΔR⁄R) than the starting sensor was obtained. In addition to that, this piezoresistive microcantilever biosensor it is more sensitive than the other similar sensors previously reported in the open literature. The mechanical sensitivity of the final senior is -1.5×10-8 Ω/Ω ⁄pN; which means that for each 1pN (10-10 g) biomolecules attach to this biosensor; the piezoresistor resistivity will decrease by 1.5×10-8 Ω. Throughout this work COMSOL Multiphysics 5.0, a commercial Finite Element Analysis (FEA) tool, has been used to simulate the sensor performance.

Keywords: biosensor, microcantilever, piezoresistive, stress concentration region (SCR)

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7376 Long-Term Field Performance of Paving Fabric Interlayer Systems to Reduce Reflective Cracking

Authors: Farshad Amini, Kejun Wen

Abstract:

The formation of reflective cracking of pavement overlays has confronted highway engineers for many years. Stress-relieving interlayers, such as paving fabrics, have been used in an attempt to reduce or delay reflective cracking. The effectiveness of paving fabrics in reducing reflection cracking is related to joint or crack movement in the underlying pavement, crack width, overlay thickness, subgrade conditions, climate, and traffic volume. The nonwoven geotextiles are installed between the old and new asphalt layers. Paving fabrics enhance performance through two mechanisms: stress relief and waterproofing. Several factors including proper installation, remedial work performed before overlay, overlay thickness, variability of pavement strength, existing pavement condition, base/subgrade support condition, and traffic volume affect the performance. The primary objective of this study was to conduct a long-term monitoring of the paving fabric interlayer systems to evaluate its effectiveness and performance. A comprehensive testing, monitoring, and analysis program were undertaken, where twelve 500-ft pavement sections of a four-lane highway were rehabilitated, and then monitored for seven years. A comparison between the performance of paving fabric treatment systems and control sections is reported. Lessons learned, and the various factors are discussed.

Keywords: monitoring, paving fabrics, performance, reflective cracking

Procedia PDF Downloads 333
7375 The Relationship between Fluctuation of Biological Signal: Finger Plethysmogram in Conversation and Anthropophobic Tendency

Authors: Haruo Okabayashi

Abstract:

Human biological signals (pulse wave and brain wave, etc.) have a rhythm which shows fluctuations. This study investigates the relationship between fluctuations of biological signals which are shown by a finger plethysmogram (i.e., finger pulse wave) in conversation and anthropophobic tendency, and identifies whether the fluctuation could be an index of mental health. 32 college students participated in the experiment. The finger plethysmogram of each subject was measured in the following conversation situations: Fun memory talking/listening situation and regrettable memory talking/ listening situation for three minutes each. Lyspect 3.5 was used to collect the data of the finger plethysmogram. Since Lyspect calculates the Lyapunov spectrum, it is possible to obtain the largest Lyapunov exponent (LLE). LLE is an indicator of the fluctuation and shows the degree to which a measure is going away from close proximity to the track in a dynamical system. Before the finger plethysmogram experiment, each participant took the psychological test questionnaire “Anthropophobic Scale.” The scale measures the social phobia trend close to the consciousness of social phobia. It is revealed that there is a remarkable relationship between the fluctuation of the finger plethysmography and anthropophobic tendency scale in talking about a regrettable story in conversation: The participants (N=15) who have a low anthropophobic tendency show significantly more fluctuation of finger pulse waves than the participants (N=17) who have a high anthropophobic tendency (F (1, 31) =5.66, p<0.05). That is, the participants who have a low anthropophobic tendency make conversation flexibly using large fluctuation of biological signal; on the other hand, the participants who have a high anthropophobic tendency constrain a conversation because of small fluctuation. Therefore, fluctuation is not an error but an important drive to make better relationships with others and go towards the development of interaction. In considering mental health, the fluctuation of biological signals would be an important indicator.

Keywords: anthropophobic tendency, finger plethymogram, fluctuation of biological signal, LLE

Procedia PDF Downloads 238
7374 Empath vs Narcissist Among University Sports Persons

Authors: Jaskarn Singh Sidhu

Abstract:

The present study investigated the relationship of Empathy and Narcissism among university sports persons. Sample-The sample of the study consists of a total of 248 sportspersons and non-sports persons. Tools- To evaluate empathy, a 16-scale questionnaire was used and to evaluate narcissism, NPI-16 questionnaire was used. Statically-Two-Way Analysis of Variance used to analyse the data collected to establish the relationship. Results- In empathy male champion players shows more empathy than female counterparts the results also reveals that non champion females showed more empathy than non-champion male sports persons. In totality champion shows more empathy than non- champions. Results of Narcissism revealed that male champion sports persons were high on Narcissism scale then female counterparts. Non -champion males also indicate high narcissism then non champion female sports persons indicating female were less self -oriented then male sports persons. Conclusion- From the results it was concluded that no significant difference exists among sports persons in empathy and narcissism with reference to gender and sports performance.

Keywords: champion, narcissism, empathy, non champion players

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7373 Risk and Protective Factors for the Health of Primary Care-Givers of Children with Autism Spectrum Disorders or Intellectual Disability: A Narrative Review and Discussion

Authors: Jenny Fairthorne, Yuka Mori, Helen Leonard

Abstract:

Background: Primary care-givers of children with autism spectrum disorder (ASD) or intellectual disability (ID) have poorer health and quality of life (QoL) than primary care-givers (hereafter referred to as just care-givers) of typically developing children. We aimed to review original research which described factors impacting the health of care-givers of children with ASD or ID and to discuss how these factors might influence care-giver health. Methods: We searched Web of Knowledge, Medline, Scopus and Google Scholar using selections of words from each of three groups. The first comprised terms associated with ASD and ID and included autism, pervasive development disorder, intellectual disability, mental retardation, disability, disabled, Down and Asperger. The second included terms related to health such as depression, physical, mental, psychiatric, psychological and well-being. The third was terms related to care-givers such as mother, parent and care-giver. We included an original paper in our review if it was published between 1st January 1990 and 31st December, 2016, described original research in a peer-reviewed journal and was written in English. Additional criteria were that the research used a study population of 15 persons or more; described a risk or protective factor for the health of care-givers of a child with ASD, ID or a sub-type (such as ASD with ID or Down syndrome). Using previous research, we developed a simple and objective five-level tool to assess the strength of evidence provided by the reviewed papers. Results: We retained 33 papers. Factors impacting primary care-giver health included child behaviour, level of support, socio-economic status (SES) and diagnostic issues. Challenging child behaviour, the most commonly identified risk factor for poorer care-giver health and QoL was reported in ten of the studies. A higher level of support was associated with improved care-giver health and QoL. For example, substantial evidence indicated that family support reduced care-giver burden in families with a child with ASD and that family and neighbourhood support was associated with improved care-giver mental health. Higher socio-economic status (SES) was a protective factor for care-giver health and particularly maternal health. Diagnostic uncertainty and an unclear prognosis are factors which can cause the greatest concern to care-givers of children with ASD and those for whom a cause of their child’s ID has not been identified. We explain how each of these factors might impact caregiver health and how they might act differentially in care-givers of children with different types of ASD or ID (such as Down syndrome and ASD without ID). Conclusion: Care-givers of children with ASD may be more likely to experience many risk factors and less likely to experience the protective factors we identified for poorer mental health. Interventions to reduce risk factors and increase protective factors could pave the way for improved care-giver health. For example, workshops to train care-givers to better manage challenging child behaviours and earlier diagnosis of ASD (and particularly ASD without ID) would seem likely to improve care-giver well-being. Similarly, helping to expand support networks might reduce care-giver burden and stress leading to improved health.

Keywords: autism, caregivers, health, intellectual disability, mothers, review

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7372 Approach-Avoidance Conflict in the T-Maze: Behavioral Validation for Frontal EEG Activity Asymmetries

Authors: Eva Masson, Andrea Kübler

Abstract:

Anxiety disorders (AD) are the most prevalent psychological disorders. However, far from most affected individuals are diagnosed and receive treatment. This gap is probably due to the diagnosis criteria, relying on symptoms (according to the DSM-5 definition) with no objective biomarker. Approach-avoidance conflict tasks are one common approach to simulate such disorders in a lab setting, with most of the paradigms focusing on the relationships between behavior and neurophysiology. Approach-avoidance conflict tasks typically place participants in a situation where they have to make a decision that leads to both positive and negative outcomes, thereby sending conflicting signals that trigger the Behavioral Inhibition System (BIS). Furthermore, behavioral validation of such paradigms adds credibility to the tasks – with overt conflict behavior, it is safer to assume that the task actually induced a conflict. Some of those tasks have linked asymmetrical frontal brain activity to induced conflicts and the BIS. However, there is currently no consensus for the direction of the frontal activation. The authors present here a modified version of the T-Maze paradigm, a motivational conflict desktop task, in which behavior is recorded simultaneously to the recording of high-density EEG (HD-EEG). Methods: In this within-subject design, HD-EEG and behavior of 35 healthy participants was recorded. EEG data was collected with a 128 channels sponge-based system. The motivational conflict desktop task consisted of three blocks of repeated trials. Each block was designed to record a slightly different behavioral pattern, to increase the chances of eliciting conflict. This variety of behavioral patterns was however similar enough to allow comparison of the number of trials categorized as ‘overt conflict’ between the blocks. Results: Overt conflict behavior was exhibited in all blocks, but always for under 10% of the trials, in average, in each block. However, changing the order of the paradigms successfully introduced a ‘reset’ of the conflict process, therefore providing more trials for analysis. As for the EEG correlates, the authors expect a different pattern for trials categorized as conflict, compared to the other ones. More specifically, we expect an elevated alpha frequency power in the left frontal electrodes at around 200ms post-cueing, compared to the right one (relative higher right frontal activity), followed by an inversion around 600ms later. Conclusion: With this comprehensive approach of a psychological mechanism, new evidence would be brought to the frontal asymmetry discussion, and its relationship with the BIS. Furthermore, with the present task focusing on a very particular type of motivational approach-avoidance conflict, it would open the door to further variations of the paradigm to introduce different kinds of conflicts involved in AD. Even though its application as a potential biomarker sounds difficult, because of the individual reliability of both the task and peak frequency in the alpha range, we hope to open the discussion for task robustness for neuromodulation and neurofeedback future applications.

Keywords: anxiety, approach-avoidance conflict, behavioral inhibition system, EEG

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7371 Comparison of Regime Transition between Ellipsoidal and Spherical Particle Assemblies in a Model Shear Cell

Authors: M. Hossain, H. P. Zhu, A. B. Yu

Abstract:

This paper presents a numerical investigation of regime transition of flow of ellipsoidal particles and a comparison with that of spherical particle assembly. Particle assemblies constituting spherical and ellipsoidal particle of 2.5:1 aspect ratio are examined at separate instances in similar flow conditions in a shear cell model that is numerically developed based on the discrete element method. Correlations among elastically scaled stress, kinetically scaled stress, coordination number and volume fraction are investigated, and show important similarities and differences for the spherical and ellipsoidal particle assemblies. In particular, volume fractions at points of regime transition are identified for both types of particles. It is found that compared with spherical particle assembly, ellipsoidal particle assembly has higher volume fraction for the quasistatic to intermediate regime transition and lower volume fraction for the intermediate to inertial regime transition. Finally, the relationship between coordination number and volume fraction shows strikingly distinct features for the two cases, suggesting that different from spherical particles, the effect of the shear rate on the coordination number is not significant for ellipsoidal particles. This work provides a glimpse of currently running work on one of the most attractive scopes of research in this field and has a wide prospect in understanding rheology of more complex shaped particles in light of the strong basis of simpler spherical particle rheology.

Keywords: DEM, granular rheology, non-spherical particles, regime transition

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7370 Resilience in Patients with Chronic Kidney Disease in Hemodialysis

Authors: Gomes C. C. Izabel, Lanzotti B. Rafaela, Orlandi S. Fabiana

Abstract:

Chronic Kidney Disease is considered a serious public health problem. The exploitation of resilience has been guided by studies conducted in various contexts, especially in hemodialysis, since the impact of diagnosis and restrictions produced during the treatment process because, despite advances in treatment, remains the stigma of the disease and the feeling of pain, hopelessness, low self-esteem and disability. The objective was to evaluate the level of resilience of patients in chronic renal dialysis. This is a descriptive, correlational, cross and quantitative research. The sample consisted of 100 patients from a Renal Replacement Therapy Unit in the countryside of São Paulo. For data collection were used the characterization instrument of Participants and the Resilience Scale. There was a predominance of males (70.0%) were Caucasian (45.0%) and had completed elementary education (34.0%). The average score obtained through the Resilience Scale was 131.3 (± 20.06) points. The resiliency level submitted may be considered satisfactory. It is expected that this study will assist in the preparation of programs and actions in order to avoid possible situations of crises faced by chronic renal patients.

Keywords: hemodialysis units, renal dialysis, renal insufficiency chronic, resilience psychological

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7369 Experimental Investigations on Ultimate Bearing Capacity of Soft Soil Improved by a Group of End-Bearing Column

Authors: Mamata Mohanty, J. T. Shahu

Abstract:

The in-situ deep mixing is an effective ground improvement technique which involves columnar inclusion into soft ground to increase its bearing capacity and reduce settlement. The first part of the study presents the results of unconfined compression on cement-admixed clay prepared at different cement content and subjected to varying curing periods. It is found that cement content is a prime factor controlling the strength of the cement-admixed clay. Besides cement content, curing period is important parameter that adds to the strength of cement-admixed clay. Increase in cement content leads to significant increase in Unconfined Compressive Strength (UCS) values especially at cement contents greater than 8%. The second part of the study investigated the bearing capacity of the clay ground improved by a group of end-bearing column using model tests under plain-strain condition. This study mainly focus to examine the effect of cement contents on the ultimate bearing capacity and failure stress of the improved clay ground. The study shows that the bearing capacity of the improved ground increases significantly with increase in cement contents of the soil-cement columns. A considerable increase in the stiffness of the model ground and failure stress was observed with increase in cement contents.

Keywords: bearing capacity, cement content, curing time, unconfined compressive strength, undrained shear strength

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7368 Translation in Greek and Psychometric Properties of the 9-Item Internet Gaming Disorder Scale-Short Form (IGDS9-Sf)

Authors: Aspasia Simpsi

Abstract:

The aim of this study was to translate into Greek and then validate the psychometric properties of the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) (Pontes & Griffiths, 2015). This is the first short standardized psychometric tool to assess Internet Gaming Disorder (IGD) according to the DSM-V nine clinical criteria and among the most frequently examined. The translation of the test was done through the process of back-translation. To gain a better insight into the psychometric properties of this test, the questionnaire included demographic questions and the Greek version of the Internet Addiction Test (Young, 1998). The participants of the study were 241 adolescents aged between 12 to 18. They were nationally recruited in Greece through an online survey that was hosted on the platform of Qualtrics. Analysis revealed excellent reliability with Cronbach’s alpha coefficients α = .939 for IGDS9-SF and α = .940 for IAT. The use of Pearson product-moment correlation revealed a significant positive relationship between IGDS9-SF and IAT r (241) =.45, p < .001. Due to inconsistencies in terminology and tests in the field of IGD, what is recommended for future research is a consensus regarding IGD testing and research.

Keywords: internet gaming disorder, IGDS9-SF, psychometric properties, internet addiction

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7367 Organic Pollution of Waters and Sediments in the Middle and Lower Valley of the Medjerda, Tunisia

Authors: Samia Khadhar, Anis Chekirbene, Nouha Khiari, Amira Mabrouki

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The persistent organic pollutants (POPs) in aquatic environments are one of the most worrying problems for environmental sustainability and human health because of their carcinogenic and toxic characteristics. Human anthropogenic actions (wastewater discharges, agricultural and industrial activities) without prior treatment are the main cause of this organic pollution. Oued Madjerda is considered the most important river in Tunisia, hence the importance of assessing the level of organic pollution of water and sediments, taking into account the anthropogenic stress exerted on this river. Water and sediment samples were taken from the middle and lower valley of the Medjerda to determine the state of contamination by 7PCBs, priority 15PAHs, and pesticides. The analysis was performed by gas chromatography (GC) and liquid phase coupled to HPLC MS-MS mass spectroscopy. The results showed that for the waters, the total PAH and PCB contents vary respectively from 0.0023 to 7.72 mg/l and from 0.0001 to 0.179 mg/l. In surface sediments 0 to 15 cm, 7PCB levels vary from 1,112 to 110,062 µg/kg-1. In this study, we tried to determine the concentration of 96 pesticides in surface sediments; analyzes showed the presence of Buprofezin, propamocarb-HCl, hexaconazole, flutriafol, quinalphos, and tebufenpyrad with concentrations varying from 1.06 to 2.388 µg/kg-1. The pace of the spatial variation confirms the impact of wastewater discharged on the quality of water and sediments despite the perennial aspect of the river.

Keywords: Wadi Madjerda, organic pollution, water and sediments surface, anthropics stress

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7366 Water Productivity and Sensitivity Tolerance Stress Indices in Five Soybean Cultivars (Glycine max L.) at Different Levels of Water Deficit

Authors: Hassan Masoumi, Rashed Alavi, Mahmoud Reza Khorshidian

Abstract:

In order to measure the water deficit stress effects on seed yield and water productivity of soybean cultivars, a two field experiments wad conducted out via split plot in a randomized complete block design with four replications in 2011 and 2012. Irrigation treatments were three levels (S1; 50, S2; 62.5 and S3; 150 mm) that applied based on evaporation from the ‘class A’ pan. Cultivars were L17, Clean, T.M.S, Williams×Chippewa and M9, too. The results showed that, only extreme water deficit stresses (S3) was reduced number of pods per plants, dry weight, seed yield and also water productivity and water economic productivity, significantly. Among cultivars and at the first and second levels of irrigation (S1, S2) cultivar of L17 and at the third level (S3) cultivar of Wiiliams*Chippwea had the highest seed yield, water productivity and water economic productivity. There were observed a positive and significant correlation between seed yield with number of pods per plants and plants dry weight, too. Also, despite the reduction in water consumption at level of S2 than S1 and due to the lack of a significant reduction in seed yield, water productivity and water economic productivity was also increased, significantly (P < 0.01). All indices of sensitivity and tolerance (SSI, STI and GMP) investigated in this study showed that at the moderate and extreme water deficit stresses (S2, S3), the cultivars of L17 and Wiiliams * Chippwea had the highest tolerance and lowest sensitivity among the cultivars.

Keywords: drought, sensitivity indices, yield components, seed

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7365 Nonlinear Finite Element Analysis of Concrete Filled Steel I-Girder Bridge

Authors: Waheed Ahmad Safi, Shunichi Nakamura

Abstract:

Concrete filled steel I-girder (CFIG) bridge was proposed and the bending and shear strength was confirmed by experiments. The area surrounded by the upper and lower flanges and the web is filled with concrete in CFIG, which is used to the intermediate support of a continuous girder. Three-dimensional finite element models were established to simulate the bending and shear behaviors of CFIG and to clarify the load transfer mechanism. Steel plates and filled concrete were modeled as a three-dimensional 8-node solid element and steel reinforcement bars as a three-dimensional 2-node truss element. The elements were mostly divided into the 50 x 50 mm mesh size. The non-linear stress-strain relation is assumed for concrete in compression including the softening effect after the peak, and the stress increases linearly for concrete in tension until concrete cracking but then decreases due to tension stiffening effect. The stress-strain relation for steel plates was tri-linear and that for reinforcements was bi-linear. The concrete and the steel plates were rigidly connected. The developed FEM model was applied to simulate and analysis the bending behaviors of the CFIG specimens. The vertical displacements and the strains of steel plates and the filled concrete obtained by FEM agreed very well with the test results until the yield load. The specimens collapsed when the upper flange buckled or the concrete spalled off. These phenomena cannot be properly analyzed by FEM, which produces a small discrepancy at the ultimate states. The FEM model was also applied to simulate and analysis the shear tests of the CFIG specimens. The vertical displacements and strains of steel and concrete calculated by FEM model agreed well with the test results. A truss action was confirmed by the FEM and the experiment, clarifying that shear forces were mainly resisted by the tension strut of the steel plate and the compression strut of the filled concrete acting in the diagonal direction. A trail design with the CFIG was carried out for a four-span continuous highway bridge and the design method was established. Construction cost was estimated about 12% lower than that of a conventional steel I-section girder.

Keywords: concrete filled steel I-girder, bending strength, FEM, limit states design, steel I-girder, shear strength

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7364 Assessment of Nurses’ Knowledge of the Glasgow Coma Scale in a Saudi Tertiary Care Hospital: A Cross-Sectional Study

Authors: Roaa Al Sharif, Salsabil Abo Al-Azayem, Nimah Alsomali, Wjoud Alsaeed, Nawal Alshammari, Abdulaziz Alwatban, Yaseen Alrabae, Razan Orfali, Faisal Alqarni, Ahmad Alrasheedi

Abstract:

from various countries have revealed that nurses possess only a basic understanding of the GCS. Regarding this matter, limited knowledge is available about the situation in Saudi Arabia. Overall, the available research suggests that there is room for improvement in the knowledge of the GCS among nurses in Saudi Arabia. Further training and education programs may be beneficial in enhancing nurses' understanding and application of the GCS in clinical practice. Objective: To determine the level of knowledge and competence in assessing the GCS among staff nurses and to identify factors that might influence their knowledge at King Fahd Medical City in Riyadh, Saudi Arabia. Methods: A descriptive, cross-sectional survey involving 199 KFMC staff nurses was conducted. Nurses were provided with a structured questionnaire, and data were collected and analyzed using SPSS version 16, employing descriptive statistics and Chi-square tests. Results: The majority, 81.4% of nurses, had an average level of knowledge in assessing the Glasgow Coma Scale (GCS). The mean score for measuring the level of knowledge among staff nurses in GCS assessment was 8.8 ± 1.826. Overall, 13.6% of respondents demonstrated good knowledge of the GCS, scoring between 11 and 15 points, while only 5% of nurses exhibited poor knowledge of the GCS assessment. There was a significant correlation between knowledge and nurses' departments (χ2(2) = 19.184, p < 0.001). χ2(2) = 19.184," representing a Chi-square statistic with 2 degrees of freedom used to test the association between categorical variables in the data analysis. Conclusion: The findings indicate that knowledge of GCS assessment among staff nurses in a single center in Saudi Arabia is moderate. Therefore, there is a need for continuous education programs to enhance their competence in using this assessment.

Keywords: Glasgow Coma Scale, brain injury, nurses’ knowledge assessment, continuous education programs

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7363 Influence of Copper-Methionine on Hematological and Biochemical Changes and Ascites Incidence in Cold-Stressed Broilers

Authors: M. Bagheri Varzaneh, H. R. Rahmani, R. Jahanian

Abstract:

The present study aimed to investigate the effects of copper-methionine on ascites incidence and hematological, morphological and enzymatic responses in broiler chickens. A total of 480 one-day-old Ross 308 broiler chicks were used in a completely randomized design in a 2×3 factorial arrangement of treatments including two ambient temperatures (thermoneutral and cold stress) and three copper levels (0, 100, and 200 mg/kg as copper-methionine) with 4 replicates (20 birds in each replicate). Broilers were kept in an environmentally-controlled room from 1 to 28 days; then, half of them exposed to cold temperature from 28 to 45 days of age. The birds were sacrificed at days 38 and 45 of age. Heparinized blood samples were collected to measure hematocrit, hemoglobin concentration, red blood cell (RBC) count, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Heart, lungs, liver, and spleen were collected and weighed separately on a sensitive digital scale. At d 38 of age, none of hematological variables, enzymatic parameters, and relative weights of organs were affected by treatments. Ascitic broilers were observed in group subjected to cold temperature and control diet (without supplemental copper) at d 45 of age. Relative weight of lungs and relative weight of heart in broilers fed on copper-methionine supplemented diets in cold temperature were lower compared with other groups. Relative liver weight, ALT, AST activities, and hematological parameters such as hematocrit, hemoglobin concentration, red blood cell count in ascitic broilers were significantly increased. In contrast, a significant decrease of the relative weight of spleen was shown in these chickens. The results showed that dietary supplementation with copper–methionine can decrease probability of ascites incidence in broilers chicks, especially under cold condition.

Keywords: ascites, cold temperature, copper-methionine, cold-stressed broiler

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7362 Improving the Accuracy of Stress Intensity Factors Obtained by Scaled Boundary Finite Element Method on Hybrid Quadtree Meshes

Authors: Adrian W. Egger, Savvas P. Triantafyllou, Eleni N. Chatzi

Abstract:

The scaled boundary finite element method (SBFEM) is a semi-analytical numerical method, which introduces a scaling center in each element’s domain, thus transitioning from a Cartesian reference frame to one resembling polar coordinates. Consequently, an analytical solution is achieved in radial direction, implying that only the boundary need be discretized. The only limitation imposed on the resulting polygonal elements is that they remain star-convex. Further arbitrary p- or h-refinement may be applied locally in a mesh. The polygonal nature of SBFEM elements has been exploited in quadtree meshes to alleviate all issues conventionally associated with hanging nodes. Furthermore, since in 2D this results in only 16 possible cell configurations, these are precomputed in order to accelerate the forward analysis significantly. Any cells, which are clipped to accommodate the domain geometry, must be computed conventionally. However, since SBFEM permits polygonal elements, significantly coarser meshes at comparable accuracy levels are obtained when compared with conventional quadtree analysis, further increasing the computational efficiency of this scheme. The generalized stress intensity factors (gSIFs) are computed by exploiting the semi-analytical solution in radial direction. This is initiated by placing the scaling center of the element containing the crack at the crack tip. Taking an analytical limit of this element’s stress field as it approaches the crack tip, delivers an expression for the singular stress field. By applying the problem specific boundary conditions, the geometry correction factor is obtained, and the gSIFs are then evaluated based on their formal definition. Since the SBFEM solution is constructed as a power series, not unlike mode superposition in FEM, the two modes contributing to the singular response of the element can be easily identified in post-processing. Compared to the extended finite element method (XFEM) this approach is highly convenient, since neither enrichment terms nor a priori knowledge of the singularity is required. Computation of the gSIFs by SBFEM permits exceptional accuracy, however, when combined with hybrid quadtrees employing linear elements, this does not always hold. Nevertheless, it has been shown that crack propagation schemes are highly effective even given very coarse discretization since they only rely on the ratio of mode one to mode two gSIFs. The absolute values of the gSIFs may still be subject to large errors. Hence, we propose a post-processing scheme, which minimizes the error resulting from the approximation space of the cracked element, thus limiting the error in the gSIFs to the discretization error of the quadtree mesh. This is achieved by h- and/or p-refinement of the cracked element, which elevates the amount of modes present in the solution. The resulting numerical description of the element is highly accurate, with the main error source now stemming from its boundary displacement solution. Numerical examples show that this post-processing procedure can significantly improve the accuracy of the computed gSIFs with negligible computational cost even on coarse meshes resulting from hybrid quadtrees.

Keywords: linear elastic fracture mechanics, generalized stress intensity factors, scaled finite element method, hybrid quadtrees

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7361 Techno-Economic Optimization and Evaluation of an Integrated Industrial Scale NMC811 Cathode Active Material Manufacturing Process

Authors: Usama Mohamed, Sam Booth, Aliysn J. Nedoma

Abstract:

As part of the transition to electric vehicles, there has been a recent increase in demand for battery manufacturing. Cathodes typically account for approximately 50% of the total lithium-ion battery cell cost and are a pivotal factor in determining the viability of new industrial infrastructure. Cathodes which offer lower costs whilst maintaining or increasing performance, such as nickel-rich layered cathodes, have a significant competitive advantage when scaling up the manufacturing process. This project evaluates the techno-economic value proposition of an integrated industrial scale cathode active material (CAM) production process, closing the mass and energy balances, and optimizing the operation conditions using a sensitivity analysis. This is done by developing a process model of a co-precipitation synthesis route using Aspen Plus software and validated based on experimental data. The mechanism chemistry and equilibrium conditions were established based on previous literature and HSC-Chemistry software. This is then followed by integrating the energy streams, adding waste recovery and treatment processes, as well as testing the effect of key parameters (temperature, pH, reaction time, etc.) on CAM production yield and emissions. Finally, an economic analysis estimating the fixed and variable costs (including capital expenditure, labor costs, raw materials, etc.) to calculate the cost of CAM ($/kg and $/kWh), total plant cost ($) and net present value (NPV). This work sets the foundational blueprint for future research into sustainable industrial scale processes for CAM manufacturing.

Keywords: cathodes, industrial production, nickel-rich layered cathodes, process modelling, techno-economic analysis

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7360 Oxidative Status and Some Serum Macro Minerals during Estrus, Anestrous and Repeat Breeding in Cholistani Cattle

Authors: Farah Ali, Laeeq Akbar Lodhi, Riaz Hussain, Muhammad Sufyan

Abstract:

The present study was conducted to determine the macro mineral profile and biomarkers of oxidative stress in Cholistani cattle kept at a public farm and various villages in district Bahawalpur. For this purpose 90 blood samples were collected each from estrual, anestrous and repeat breeding cattle having different age and lactation number. Reproductive tract examination of all the cattle was carried out to determine the reproductive status. Blood samples without EDTA were collected for serum separation at day of estrus (normal cyclic), repeat breeder and anestrous cows. The serum calcium levels were significantly decreased (P<0.05) in anestrous (7.31±0.02 mg/dl) cattle as compared to estrus. However, these values were non-significantly different between repeat breeder and cattle having estrus phase. The concentrations of serum phosphorus were significantly higher (P<0.01) in normal estrual (4.99±0.08 mg/dl) as compared torepeat breeder (3.90±0.06 mg/dl) and anestrous (3.82±0.04 mg/dl) Cholistani cattle. Mean serum MDA (nmol/ml) levels of repeat breeder (2.68±0.18) and anestrous (2.54±0.22) were significantly(P<0.01) higher than the estrous (1.71±0.03) cattle. Moreover, the serum nitric oxide levels(µmol/L) were also increased significantly (P<0.01) in repeat breeder(58.28±4.01)and anestrous (61.40±9.40) than the normalestrous (31.67±6.71) cattle. The ratio of Ca: P in normal cyclic animals was lower (1.73:1) as compared to the anestrous animals (1.92:1). It can be concluded from the present study that the level of Ca: P should also be near to 1.5:1 for better reproductive performance.

Keywords: anestrus, cholistani cattle, minerals, oxidative stress, repeat breeder

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7359 Utilization of Synthetic and Natural Ascorbic Acid (African Locust Bean, Baobab, and Prosopis Africana) Pulp for Sustainable Broiler Production in the Era of Global Warming

Authors: Lawan Adamu, Aminu Maidala

Abstract:

Heat stress exerts a high deteriorating impact on the poultry industry which could be ameliorated by dietary incorporation of synthetic vitamin C. Certain herbs either alone or in combination thereof are also a rich source of ascorbic acid in natural form. Gashua is located in the semi arid zones with temperature ranges of 38-43oC especially in the months of March up to June/July which make survival and production much difficult to poultry especially broilers chickens as it was found that high ambient temperatures above 380C feed consumption, growth rate, feed efficiency, survivability, egg production and egg quality tends to decline. In order to address the problem of heat stress, an experiment was conducted in the month of March/April to determine the effect of synthetic ascorbic-acid (vitamin C), natural ascorbic from baobab, African locust bean and prosopis africana pulp was administer in drinking water and basal diets adlibitum. 300 day old marshal breed chicks were used for this experiment which was divided into five treatment group with 20 birds per replicate which designated as zero, synthetic ascorbic acid 40g/L, baobab pulp 40g/L, African locust pulp 40g/L and iron wood pulp 40g/L for T1, T2 T3 T4 and T5 respectively. The experiment was lasted for eight weeks (four weeks each for the starter and finisher). Data collected were subjected to analysis of variance (ANOVA) using SAS 2002 soft wire and significant difference observed means were separated using Duncan multiple range test. The result revealed that bird on control diet were significantly (p<0.05) lowered in terms total and daily weight gain and feed efficiency but significantly (p<0.05) higher in terms feed intake, water intake, rectal temperature and mortality. This study concluded that ascorbic acid increased broiler performance and reduced mortality under high temperature thereby maintain the sustainability of broiler production to bridge the gap of animal protein deficit in the hot arid zone.

Keywords: ascorbic acid, heat stress, broiler, performance

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7358 Influence of Wind Induced Fatigue Damage in the Reliability of Wind Turbines

Authors: Emilio A. Berny-Brandt, Sonia E. Ruiz

Abstract:

Steel tubular towers serving as support structures for large wind turbines are subject to several hundred million stress cycles arising from the turbulent nature of the wind. This causes high-cycle fatigue which can govern tower design. The practice of maintaining the support structure after wind turbines reach its typical 20-year design life have become common, but without quantifying the changes in the reliability on the tower. There are several studies on this topic, but most of them are based on the S-N curve approach using the Miner’s rule damage summation method, the de-facto standard in the wind industry. However, the qualitative nature of Miner’s method makes desirable the use of fracture mechanics to measure the effects of fatigue in the capacity curve of the structure, which is important in order to evaluate the integrity and reliability of these towers. Temporal and spatially varying wind speed time histories are simulated based on power spectral density and coherence functions. Simulations are then applied to a SAP2000 finite element model and step-by-step analysis is used to obtain the stress time histories for a range of representative wind speeds expected during service conditions of the wind turbine. Rainflow method is then used to obtain cycle and stress range information of each of these time histories and a statistical analysis is performed to obtain the distribution parameters of each variable. Monte Carlo simulation is used here to evaluate crack growth over time in the tower base using the Paris-Erdogan equation. A nonlinear static pushover analysis to assess the capacity curve of the structure after a number of years is performed. The capacity curves are then used to evaluate the changes in reliability of a steel tower located in Oaxaca, Mexico, where wind energy facilities are expected to grow in the near future. Results show that fatigue on the tower base can have significant effects on the structural capacity of the wind turbine, especially after the 20-year design life when the crack growth curve starts behaving exponentially.

Keywords: crack growth, fatigue, Monte Carlo simulation, structural reliability, wind turbines

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7357 Research on Knowledge Graph Inference Technology Based on Proximal Policy Optimization

Authors: Yihao Kuang, Bowen Ding

Abstract:

With the increasing scale and complexity of knowledge graph, modern knowledge graph contains more and more types of entity, relationship, and attribute information. Therefore, in recent years, it has been a trend for knowledge graph inference to use reinforcement learning to deal with large-scale, incomplete, and noisy knowledge graphs and improve the inference effect and interpretability. The Proximal Policy Optimization (PPO) algorithm utilizes a near-end strategy optimization approach. This allows for more extensive updates of policy parameters while constraining the update extent to maintain training stability. This characteristic enables PPOs to converge to improved strategies more rapidly, often demonstrating enhanced performance early in the training process. Furthermore, PPO has the advantage of offline learning, effectively utilizing historical experience data for training and enhancing sample utilization. This means that even with limited resources, PPOs can efficiently train for reinforcement learning tasks. Based on these characteristics, this paper aims to obtain a better and more efficient inference effect by introducing PPO into knowledge inference technology.

Keywords: reinforcement learning, PPO, knowledge inference

Procedia PDF Downloads 243
7356 Socio-Demographic Predictors of Divorce Adjustment in Pakistani Women

Authors: Rukhsana Kausar, Nida Zafar

Abstract:

The present research investigated socio-demographic predictors of divorce adjustment in Pakistani women. The sample comprised of 80 divorced women from different areas of Lahore. Self developed Socio-Demographic predictor scale and Divorce Adjustment Scale by (Fisher, 2001) was used for assessment. Analyses showed that working divorced women living with joint family system are more adjusted as compared to non-working divorced women living with joint family system. Women having one child are more adjusted as compared to women having more than one child. Findings highlight importance of presence of father for healthy development of adolescents. Adjustment of divorcee women was positively associated with income, social support from the family, having favorable attitudes toward marital dissolution prior to divorce, and being the partner who initiated the divorce. In addition, older women showed some evidence of poorer adjustment than did younger women. Findings highlight importance of support for divorce adjustment.

Keywords: socio-demographic, adjustment, women, divorce

Procedia PDF Downloads 468
7355 Hypoglossal Nerve Stimulation (Baseline vs. 12 months) for Obstructive Sleep Apnea: A Meta-Analysis

Authors: Yasmeen Jamal Alabdallat, Almutazballlah Bassam Qablan, Hamza Al-Salhi, Salameh Alarood, Ibraheem Alkhawaldeh, Obada Abunar, Adam Abdallah

Abstract:

Obstructive sleep apnea (OSA) is a disorder caused by the repeated collapse of the upper airway during sleep. It is the most common cause of sleep-related breathing disorder, as OSA can cause loud snoring, daytime fatigue, or more severe problems such as high blood pressure, cardiovascular disease, coronary artery disease, insulin-resistant diabetes, and depression. The hypoglossal nerve stimulator (HNS) is an implantable medical device that reduces the occurrence of obstructive sleep apnea by electrically stimulating the hypoglossal nerve in rhythm with the patient's breathing, causing the tongue to move. This stimulation helps keep the patient's airways clear while they sleep. This systematic review and meta-analysis aimed to assess the clinical outcome of hypoglossal nerve stimulation as a treatment of obstructive sleep apnea. A computer literature search of PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials was conducted from inception until August 2022. Studies assessing the following clinical outcomes (Apnea-Hypopnea Index (AHI), Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Oxygen Desaturation Indices (ODI), (Oxygen Saturation (SaO2)) were pooled in the meta-analysis using Review Manager Software. We assessed the quality of studies according to the Cochrane risk-of-bias tool for randomized trials (RoB2), Risk of Bias In Non-randomized Studies - of Interventions (ROBINS-I), and a modified version of NOS for the non-comparative cohort studies.13 Studies (Six Clinical Trials and Seven prospective cohort studies) with a total of 817 patients were included in the meta-analysis. The results of AHI were reported in 11 studies examining OSA 696 patients. We found that there was a significant improvement in the AHI after 12 months of HNS (MD = 18.2 with 95% CI, (16.7 to 19.7; I2 = 0%); P < 0.00001). Further, 12 studies reported the results of ESS after 12 months of intervention with a significant improvement in the range of sleepiness among the examined 757 OSA patients (MD = 5.3 with 95% CI, (4.75 to 5.86; I2 = 65%); P < 0.0001). Moreover, nine studies involving 699 participants reported the results of FOSQ after 12 months of HNS with a significant reported improvement (MD = -3.09 with 95% CI, (-3.41 to 2.77; I2 = 0%); P < 0.00001). In addition, ten studies reported the results of ODI with a significant improvement after 12 months of HNS among the 817 examined patients (MD = 14.8 with 95% CI, (13.25 to 16.32; I2 = 0%); P < 000001). The Hypoglossal Nerve Stimulation showed a significant positive impact on obstructive sleep apnea patients after 12 months of therapy in terms of apnea-hypopnea index, oxygen desaturation indices, manifestations of the behavioral morbidity associated with obstructive sleep apnea, and functional status resulting from sleepiness.

Keywords: apnea, meta-analysis, hypoglossal, stimulation

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