Search results for: ecological risk assessment

Authors: Orsolya Kegyes-Brassai, Zsolt Szilvágyi, Ákos Wolf, Richard P. Ray

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Local ground conditions have a substantial influence on the seismic response of structures. Their inclusion in seismic hazard assessment and structural design can be realized at different levels of sophistication. However, response results based on more advanced calculation methods e.g. nonlinear or equivalent linear site analysis tend to show significant discrepancies when compared to simpler approaches. This project's main objective was to compare results from several 1-D response programs to Eurocode 8 design spectra. Data from in-situ site investigations were used for assessing local ground conditions at several locations in Hungary. After discussion of the in-situ measurements and calculation methods used, a comprehensive evaluation of all major contributing factors for site response is given. While the Eurocode spectra should account for local ground conditions based on soil classification, there is a wide variation in peak ground acceleration determined from 1-D analyses versus Eurocode. Results show that current Eurocode 8 design spectra may not be conservative enough to account for local ground conditions typical for Hungary.

Keywords: 1-D site response analysis, multichannel analysis of surface waves (MASW), seismic CPT, seismic hazard assessment

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Authors: A. Zeynolabedin, M. A. Olyaei, B. Ghiasi

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Drought is an inevitable part of the earth’s climate. It occurs regularly with no clear warning and without recognizing borders. In addition, its impact is cumulative and not immediately discernible. Iran is located in a semi-arid region where droughts occur periodically as natural hazard. Standardized Precipitation Index (SPI), Surface Water Supply Index (SWSI), and Palmer Drought Severity Index (PDSI) are three well-known indices which describe drought severity; each has its own advantages and disadvantages and can be used for specific types of drought. These indices take into account some factors such as precipitation, reservoir storage and discharge, temperature, and potential evapotranspiration in determining drought severity. In this paper, first all three indices are calculated in Aharchay river watershed located in northwestern part of Iran in East Azarbaijan province. Next, based on two other important parameters which are groundwater level and solar radiation, two new indices are defined. Finally, considering all five aforementioned indices, a combined drought index (CDI) is presented and calculated for the region. This combined index is based on all the meteorological, hydrological, and agricultural features of the region. The results show that the most severe drought condition in Aharchay watershed happened in Jun, 2004. The result of this study can be used for monitoring drought and prepare for the drought mitigation planning.

Keywords: drought, GIS, intensity index, regional assessment, variation maps

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Authors: Sadeq Al Yaari, Nassr Almaflehi, Ayman Al Yaari, Adham Al Yaari, Montaha Al Yaari, Aayah Al Yaari, Sajedah Al Yaari

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Background: Assessment of language-related functional activities (ALFA) is of vital importance in assessing aphasics’ performance of both sexes. However, the validity and reliability of this language therapeutic test has never been validated in the Arabic medical literature. Purpose: The aim of this study was to validate the test by assessing the language-related functional activities of 100 gender aphasics based in a medical faculty. Design: ALFA Pre-and-posttest was administered twice in three weeks to test the language-related functional activities of 100 gender aphasics. Settings: Al Khars hospital in Al Ahsa’a, Kingdom of Saudi Arabia (KSA). Participants: Sixteen to eight-year-old participants (N = 100 men and women) were enrolled in this experiment. Again, the purpose was to assess their language-related functional activities using ALFA. Procedures: The first step was to translate the English version of ALFA test into the mother tongue of the patients (Arabic). Secondly, the translated text is reviewed and edited by three specialists of Arabic language. Having the test standardized, the third step was to assess language-related functional activities of the participants in natural environment. Assessment took place in three weeks. In the first week, a pre-test was administered to the participants at hand and after two weeks, a post-test was administered to identify whether or not significant differences between the two tests (pre-and-posttest) could be observed. Interventions: Outcomes of the results obtained from the analyses were broadly discussed. Linguistic and statistical comparisons were held to illustrate the findings of this study. Main outcomes and Results: The analysis of the obtained results indicated that the performance of the aphasic participants in the post-test did not differ from that of the pre-test (, respectively). Conclusions & Implications: ALFA was proved to be a valid and reliable test. Moreover, outlined results pointed out the importance of assessing not only gender aphasics’ language, but also their language-related functional activities. Further research is needed to explore how gender aphasics’ verbal and non-verbal performances interact.

Keywords: ALFA, language test, Arab aphasics, validity, reliability, psychoneurolinguistics.

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Authors: Pauline Cuenin, Marcelo Leles Romarco Oliveira

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Based on their localities and following their ecological rationality, family-based farmers have experimented, adapted and innovated to improve their production systems continuously for millennia. With the technological package transfer processes of the so-called Green Revolution for agricultural holdings, farmers have become increasingly dependent on ready-made "recipes" built from so-called "universal" and global knowledge to face the problems that emerge in the management of local agroecosystems, thus reducing their creative and experiential capacities. However, the production of novelties within farms is fundamental to the transition to more sustainable agro food systems. In fact, as the fruits of local knowledge and / or the contextualization of exogenous knowledge, novelties are seen as seeds of transition. By presenting new techniques, new organizational forms and epistemological approaches, agroecology was pointed out as a way to encourage and promote the creative capacity of farmers. From this perspective, this theoretical work aims to analyze how agroecology encourages the innovative capacity of farmers, and in general, the production of novelties. For this, an analysis was made of the theoretical and methodological bases of agroecology through a literature review, specifically looking for the way in which it articulates the local with the global, complemented by an analysis of agro ecological Brazilian experiences. It was emphasized that, based on the peasant way of doing agriculture, that is, on ecological / social co-evolution or still called co-production (interaction between human beings and living nature), agroecology recognizes and revalues peasant involves the deep interactions of the farmer with his site (bio-physical and social). As a "place science," practice and movement, it specifically takes into consideration the local and empirical knowledge of farmers, which allows questioning and modifying the paradigms that underpin the current agriculture that have disintegrated farmers' creative processes. In addition to upgrade the local, agroecology allows the dialogue of local knowledge with global knowledge, essential in the process of changes to get out of the dominant logic of thought and give shape to new experiences. In order to reach this articulation, agroecology involves new methodological focuses seeking participatory methods of study and intervention that express themselves in the form of horizontal spaces of socialization and collective learning that involve several actors with different knowledge. These processes promoted by agroecology favor the production of novelties at local levels for expansion at other levels, such as the global, through trans local agro ecological networks.

Keywords: agroecology, creativity, global, local, novelty

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Authors: A. K. Tekile, I. L. Kim, J. Y. Lee

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Human activities put freshwater quality under risk, mainly due to expansion of agriculture and industries, damming, diversion and discharge of inadequately treated wastewaters. The rapid human population growth and climate change escalated the problem. External controlling actions on point and non-point pollution sources are long-term solution to manage water quality. To have a holistic approach, these mechanisms should be coupled with the in-water control strategies. The available in-lake or river methods are either costly or they have some adverse effect on the ecological system that the search for an alternative and effective solution with a reasonable balance is still going on. This study aimed at the physical and chemical water quality improvement in a stagnant Yeo-cheon River reach (Korea), which has recently shown sign of water quality problems such as scum formation and fish death. The river water quality was monitored, for the duration of three months by operating only water flow generator in the first two weeks and then ultrasonic irradiation device was coupled to the flow unit for the remaining duration of the experiment. In addition to assessing the water quality improvement, the correlation among the parameters was analyzed to explain the contribution of the ultra-sonication. Generally, the combined strategy showed localized improvement of water quality in terms of dissolved oxygen, Chlorophyll-a and dissolved reactive phosphate. At locations under limited influence of the system operation, chlorophyll-a was highly increased, but within 25 m of operation the low initial value was maintained. The inverse correlation coefficient between dissolved oxygen and chlorophyll-a decreased from 0.51 to 0.37 when ultrasonic irradiation unit was used with the flow, showing that ultrasonic treatment reduced chlorophyll-a concentration and it inhibited photosynthesis. The relationship between dissolved oxygen and reactive phosphate also indicated that influence of ultra-sonication was higher than flow on the reactive phosphate concentration. Even though flow increased turbidity by suspending sediments, ultrasonic waves canceled out the effect due to the agglomeration of suspended particles and the follow-up settling out. There has also been variation of interaction in the water column as the decrease of pH and dissolved oxygen from surface to the bottom played a role in phosphorus release into the water column. The variation of nitrogen and dissolved organic carbon concentrations showed mixed trend probably due to the complex chemical reactions subsequent to the operation. Besides, the intensive rainfall and strong wind around the end of the field trial had apparent impact on the result. The combined effect of water flow and ultrasonic irradiation was a cumulative water quality improvement and it maintained the dissolved oxygen and chlorophyll-a requirement of the river for healthy ecological interaction. However, the overall improvement of water quality is not guaranteed as effectiveness of ultrasonic technology requires long-term monitoring of water quality before, during and after treatment. Even though, the short duration of the study conducted here has limited nutrient pattern realization, the use of ultrasound at field scale to improve water quality is promising.

Keywords: stagnant, ultrasonic irradiation, water flow, water quality

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Authors: Pratap Chandra Pati, Prabina Rajib, Parama Barai

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The traditional finance theory neglects the role of sentiment factor in asset pricing. However, the behavioral approach to asset-pricing based on noise trader model and limit to arbitrage includes investor sentiment as a priced risk factor in the assist pricing model. Investor sentiment affects stock more that are vulnerable to speculation, hard to value and risky to arbitrage. It includes small stocks, high volatility stocks, growth stocks, distressed stocks, young stocks and non-dividend-paying stocks. Since the introduction of Chicago Board Options Exchange (CBOE) volatility index (VIX) in 1993, it is used as a measure of future volatility in the stock market and also as a measure of investor sentiment. CBOE VIX index, in particular, is often referred to as the ‘investors’ fear gauge’ by public media and prior literature. The upward spikes in the volatility index are associated with bouts of market turmoil and uncertainty. High levels of the volatility index indicate fear, anxiety and pessimistic expectations of investors about the stock market. On the contrary, low levels of the volatility index reflect confident and optimistic attitude of investors. Based on the above discussions, we investigate whether market-wide fear levels measured volatility index is priced factor in the standard asset pricing model for the Indian stock market. First, we investigate the performance and validity of Fama and French three-factor model and Carhart four-factor model in the Indian stock market. Second, we explore whether India volatility index as a proxy for fearful market-based sentiment indicators affect the cross section of stock returns after controlling for well-established risk factors such as market excess return, size, book-to-market, and momentum. Asset pricing tests are performed using monthly data on CNX 500 index constituent stocks listed on the National stock exchange of India Limited (NSE) over the sample period that extends from January 2008 to March 2017. To examine whether India volatility index, as an indicator of fear sentiment, is a priced risk factor, changes in India VIX is included as an explanatory variable in the Fama-French three-factor model as well as Carhart four-factor model. For the empirical testing, we use three different sets of test portfolios used as the dependent variable in the in asset pricing regressions. The first portfolio set is the 4x4 sorts on the size and B/M ratio. The second portfolio set is the 4x4 sort on the size and sensitivity beta of change in IVIX. The third portfolio set is the 2x3x2 independent triple-sorting on size, B/M and sensitivity beta of change in IVIX. We find evidence that size, value and momentum factors continue to exist in Indian stock market. However, VIX index does not constitute a priced risk factor in the cross-section of returns. The inseparability of volatility and jump risk in the VIX is a possible explanation of the current findings in the study.

Keywords: India VIX, Fama-French model, Carhart four-factor model, asset pricing

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Authors: Guo Yu, Haoming Ma, Peiru Zhou

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BACKGROUND: In addition to hyperglycemia, hypoglycemia, and glycemic variability, a decrease in the time in the targeted blood glucose range (TIR) may be associated with an increased risk of death for critically ill patients. However, the relationship between the TIR and mortality may be influenced by the presence of diabetes and glycemic variability. METHODS: A total of 998 diabetic and non-diabetic patients with severe diseases in the ICU were selected for this retrospective analysis. The TIR is defined as the percentage of time spent in the target blood glucose range of 3.9–10.0 mmol/L within 24 hours. The relationship between TIR and in-hospital in diabetic and non-diabetic patients was analyzed. The effect of glycemic variability was also analyzed. RESULTS: The binary logistic regression model showed that there was a significant association between the TIR as a continuous variable and the in-hospital death of severely ill non-diabetic patients (OR=0.991, P=0.015). As a classification variable, TIR≥70% was significantly associated with in-hospital death (OR=0.581, P=0.003). Specifically, TIR≥70% was a protective factor for the in-hospital death of severely ill non-diabetic patients. The TIR of severely ill diabetic patients was not significantly associated with in-hospital death; however, glycemic variability was significantly and independently associated with in-hospital death (OR=1.042, P=0.027). Binary logistic regression analysis of comprehensive indices showed that for non-diabetic patients, the C3 index (low TIR & high CV) was a risk factor for increased mortality (OR=1.642, P<0.001). In addition, for diabetic patients, the C3 index was an independent risk factor for death (OR=1.994, P=0.008), and the C4 index (low TIR & low CV) was independently associated with increased survival. CONCLUSIONS: The TIR of non-diabetic patients during ICU hospitalization was associated with in-hospital death even after adjusting for disease severity and glycemic variability. There was no significant association between the TIR and mortality of diabetic patients. However, for both diabetic and non-diabetic critically ill patients, the combined effect of high TIR and low CV was significantly associated with ICU mortality. Diabetic patients seem to have higher blood glucose fluctuations and can tolerate a large TIR range. Both diabetic and non-diabetic critically ill patients should maintain blood glucose levels within the target range to reduce mortality.

Keywords: severe disease, diabetes, blood glucose control, time in targeted blood glucose range, glycemic variability, mortality

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Authors: Namrata Khatri

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The rapid growth of cities is transforming the urban environment and posing significant challenges for environmental quality. This study examines the urban environment of Belagavi in Karnataka, India, using geostatistical methods to assess the spatial pattern and land use distribution of the city and to evaluate the quality of the urban environment. The study is driven by the necessity to assess the environmental impact of urbanisation. Satellite data was utilised to derive information on land use and land cover. The investigation revealed that land use had changed significantly over time, with a drop in plant cover and an increase in built-up areas. High-resolution satellite data was also utilised to map the city's open areas and gardens. GIS-based research was used to assess public green space accessibility and to identify regions with inadequate waste management practises. The findings revealed that garbage collection and disposal techniques in specific areas of the city needed to be improved. Moreover, the study evaluated the city's thermal environment using Landsat 8 land surface temperature (LST) data. The investigation found that built-up regions had higher LST values than green areas, pointing to the city's urban heat island (UHI) impact. The study's conclusions have far-reaching ramifications for urban planners and politicians in Belgaum and other similar cities. The findings may be utilised to create sustainable urban planning strategies that address the environmental effect of urbanisation while also improving the quality of life for city dwellers. Satellite data and high-resolution satellite pictures were gathered for the study, and remote sensing and GIS tools were utilised to process and analyse the data. Ground truthing surveys were also carried out to confirm the accuracy of the remote sensing and GIS-based data. Overall, this study provides a complete assessment of Belgaum's environmental quality and emphasizes the potential of remote sensing and geographic information systems (GIS) approaches in environmental assessment and management.

Keywords: environmental quality, UEQ, remote sensing, GIS

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Authors: Azza A. Ali, Doaa M. Abd El-Latif, Amany M. Gad, Yasser M. A. Elnahas, Karema Abu-Elfotuh

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Background: Exposure to Aluminium (Al) has been increased recently. It is found in food products, food additives, drinking water, cosmetics and medicines. Chronic consumption of Al causes oxidative stress and has been implicated in several chronic disorders. Liver is considered as the major site for detoxification while kidney is involved in the elimination of toxic substances and is a target organ of metal toxicity. Social isolation (SI) or protein malnutrition (PM) also causes oxidative stress and has negative impact on Al-induced nephrotoxicity as well as hepatotoxicity. Coenzyme Q10 (CoQ10) is a powerful intracellular antioxidant with mitochondrial membrane stabilizing ability while wheat grass is a natural product with antioxidant, anti-inflammatory and different protective activities, cocoa is also potent antioxidants and can protect against many diseases. They provide different degrees of protection from the impact of oxidative stress. Objective: To study the impact of social isolation together with Protein malnutrition on nephro- and hepato-toxicity induced by chronic Al exposure in rats as well as to investigate the postulated protection using a combination of Co Q10, wheat grass and cocoa. Methods: Eight groups of rats were used; four served as protected groups and four as un-protected. Each of them received daily for five weeks AlCl3 (70 mg/kg, IP) for Al-toxicity model groups except one group served as control. Al-toxicity model groups were divided to Al-toxicity alone, SI- associated PM (10% casein diet) and Al- associated SI&PM groups. Protection was induced by oral co-administration of CoQ10 (200mg/kg), wheat grass (100mg/kg) and cocoa powder (24mg/kg) combination together with Al. Biochemical changes in total bilirubin, lipids, cholesterol, triglycerides, glucose, proteins, creatinine and urea as well as alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), lactate deshydrogenase (LDH) were measured in serum of all groups. Specimens of kidney and liver were used for assessment of oxidative parameters (MDA, SOD, TAC, NO), inflammatory mediators (TNF-α, IL-6β, nuclear factor kappa B (NF-κB), Caspase-3) and DNA fragmentation in addition to evaluation of histopathological changes. Results: SI together with PM severely enhanced nephro- and hepato-toxicity induced by chronic Al exposure. Co Q10, wheat grass and cocoa combination showed clear protection against hazards of Al exposure either alone or when associated with SI&PM. Their protection were indicated by the significant decrease in Al-induced elevations in total bilirubin, lipids, cholesterol, triglycerides, glucose, creatinine and urea levels as well as ALT, AST, ALP, LDH. Liver and kidney of the treated groups also showed significant decrease in MDA, NO, TNF-α, IL-6β, NF-κB, caspase-3 and DNA fragmentation, together with significant increase in total proteins, SOD and TAC. Biochemical results were confirmed by the histopathological examinations. Conclusion: SI together with PM represents a risk factor in enhancing nephro- and hepato-toxicity induced by Al in rats. CoQ10, wheat grass and cocoa combination provide clear protection against nephro- and hepatotoxicity as well as the consequent degenerations induced by chronic Al-exposure even when associated with the risk of SI together with PM.

Keywords: aluminum, nephrotoxicity, hepatotoxicity, isolation and protein malnutrition, coenzyme Q10, wheatgrass, cocoa, nutrients combinations

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Authors: Andrea Paltrinieri, Alberto Dreassi, Stefano Miani, Alex Sclip

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The financial crises caused a collapse in prices of most asset classes, raising the attention on alternative investments such as Sukuk, a smaller, fast growing but often misunderstood market. We study diversification benefits of Sukuk, their correlation with other asset classes and the effects of their inclusion in investment portfolios of institutional and retail investors, through a comprehensive comparison of their risk/return profiles during and after the financial crisis. We find a beneficial performance adjusted for the specific volatility together with a lower correlation especially during the financial crisis. The distribution of Sukuk returns is positively skewed and leptokurtic, with a risk/return profile similarly to high yield bonds. Overall, our results suggest that Sukuk present diversification opportunities, a significant volatility-adjusted performance and lower correlations especially during the financial crisis. Our findings are relevant for a number of institutional investors. Long term investors, such as life insurers would benefit from Sukuk’s protective features during financial crisis yet keeping return and growth opportunities, whereas banks would gain due to their role of placers, advisors, market makers or underwriters.

Keywords: sukuk, zero beta asset, asset allocation, sukuk market

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Authors: Caio E. G. Reis, Jose G. Dórea, Teresa H. M. da Costa

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Objective: Epidemiological data shows an inverse association of coffee consumption with risk of type 2 diabetes mellitus. However, the clinical effects of coffee consumption on the glucose metabolism biomarkers remain controversial. Thus, this paper reviews clinical trials that evaluated the effects of coffee consumption on glucose metabolism. Research Design and Methods: We identified studies published until December 2014 by searching electronic databases and reference lists. We included randomized clinical trials which the intervention group received caffeinated and/or decaffeinated coffee and the control group received water or placebo treatments and measured biomarkers of glucose metabolism. The Jadad Score was applied to evaluate the quality of the studies whereas studies that scored ≥ 3 points were considered for the analyses. Results: Seven clinical trials (total of 237 subjects) were analyzed involving adult healthy, overweight and diabetic subjects. The studies were divided in short-term (1 to 3h) and long-term (2 to 16 weeks) duration. The results for short-term studies showed that caffeinated coffee consumption may increase the area under the curve for glucose response, while for long-term studies caffeinated coffee may improve the glycemic metabolism by reducing the glucose curve and increasing insulin response. These results seem to show that the benefits of coffee consumption occur in the long-term as has been shown in the reduction of type 2 diabetes mellitus risk in epidemiological studies. Nevertheless, until the relationship between long-term coffee consumption and type 2 diabetes mellitus is better understood and any mechanism involved identified, it is premature to make claims about coffee preventing type 2 diabetes mellitus. Conclusion: The findings suggest that caffeinated coffee may impairs glucose metabolism in short-term but in the long-term the studies indicate reduction of type 2 diabetes mellitus risk. More clinical trials with comparable methodology are needed to unravel this paradox.

Keywords: coffee, diabetes mellitus type 2, glucose, insulin

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Authors: Ali Osman Güney, Bahattin Kanber

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In this work, the effect of material type, diameter, orientation and closeness of fibers on the general performance of reinforced vulcanized rubbers are investigated using finite element method with experimental verification. Various fiber materials such as hemp, nylon, polyester are used for different fiber diameters, orientations and closeness. 3D finite element models are developed by considering bonded contact elements between fiber and rubber sheet interfaces. The fibers are assumed as linear elastic, while vulcanized rubber is considered as hyper-elastic. After an experimental verification of finite element results, the developed models are analyzed under prescribed displacement that causes tension. The normal stresses in fibers and shear stresses between fibers and rubber sheet are investigated in all models. Large deformation of reinforced rubber sheet also represented with various fiber conditions under incremental loading. A general assessment is achieved about best fiber properties of reinforced rubber sheets for tension-load conditions.

Keywords: reinforced vulcanized rubbers, fiber properties, out of plane loading, finite element method

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Authors: Ahmed Mudi, Bala Zakar

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The paper assesses the impact of safe motherhood initiative on maternal health of women in Gumel Local Government Area of Jigawa State. The work will specifically concentrate on the background on safe motherhood scheme and maternal health of women. The objective of this paper is to assess the level of safe motherhood scheme in Gumel local government area, to find out the level of maternal health in Gumel local government as well as to determine the impact of safe motherhood scheme on maternal health on women in Gumel Local Government Area Jigawa State. Various literature on the topic are reviewed, the paper adopts survey design and use questionnaire to collect data from the respondent. The study comprises 350 women selected from six rural communities in Gumel using random sampling techniques, and the data was analysed by simple frequency and percentage. The research concluded that safe motherhood initiative has a significant impact on the maternal health of women in Gumel Local Government Area of Jigawa State. Finally, suitable recommendations were given on how to improve the scheme to ensure better maternal health in the region.

Keywords: action, assessment, maternal health, safe motherhood, surgery

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Authors: Runlin Liu, Shilong Li

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China is a mountainous country, with two-thirds of its territory covered by plateaus, hills, and mountains, and nearly half of the cities and towns are distributed in mountainous areas. Compared with the environmental constraints in the development path of cities and towns in the plains, there are heterogeneities in aspects such as spatial characteristics, growth mode, and ecological protection and so on for mountain village and townlets, and the development path of mountain village and townlets has a bidirectional relationship between mountain space and economic growth. Based on classical growth theory, this article explores the two-dimensional coupling relation between space and economy in mountain village and townlets under background of rural rejuvenation. GIS technology is adopted in the study to analyze spatial trends and patterns, economical spatial differentiation characteristics of village and townlets. This powerful tool can also help differentiate and analyze limiting factors and assessment systems in the economic growth of village and townlets under spatial dimension of mountainous space. To make the research more specific, this article selects mountain village and townlets in Southwest China as the object of study; this provides good cases for analyzing parallel coupling mechanism of the duality structure system between economic growth and spatial expansion and discussing the path selection of spatial economic growth of mountain village and towns with multiple constraints. The research results can provide quantitative references for the spatial and economic development paths of mountain villages and towns, which is helpful in realizing efficient and high-quality development mode with equal emphasis on spatial and economic benefits for these type of towns.

Keywords: coupling mechanism, geographic information technology, mountainous town, synergetic development, spatial economy

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Authors: Omar Nouri, Wafa Mnejja, Fatma Dhouib, Syrine Zouari, Wicem Siala, Ilhem Charfeddine, Afef Khanfir, Leila Farhat, Nejla Fourati, Jamel Daoud

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Purpose and Objective: Intensity modulated radiation (IMRT) technique, associated with induction chemotherapy (IC) and/or concomitant chemotherapy (CC), is actually the recommended treatment modality for nasopharyngeal carcinomas (NPC). The aim of this study was to evaluate the therapeutic results and the patterns of relapse with this treatment protocol. Material and methods: A retrospective monocentric study of 145 patients with NPC treated between June 2016 and July 2021. All patients received IMRT with integrated simultaneous boost (SIB) of 33 daily fractions at a dose of 69.96 Gy for high-risk volume, 60 Gy for intermediate risk volume and 54 Gy for low-risk volume. The high-risk volume dose was 66.5 Gy in children. Survival analysis was performed according to the Kaplan-Meier method, and the Log-rank test was used to compare factors that may influence survival. Results: Median age was 48 years (11-80) with a sex ratio of 2.9. One hundred-twenty tumors (82.7%) were classified as stages III-IV according to the 2017 UICC TNM classification. Ten patients (6.9%) were metastatic at diagnosis. One hundred-thirty-five patient (93.1%) received IC, 104 of which (77%) were TPF-based (taxanes, cisplatin and 5 fluoro-uracil). One hundred-thirty-eight patient (95.2%) received CC, mostly cisplatin in 134 cases (97%). After a median follow-up of 50 months [22-82], 46 patients (31.7%) had a relapse: 12 (8.2%) experienced local and/or regional relapse after a median of 18 months [6-43], 29 (20%) experienced distant relapse after a median of 9 months [2-24] and 5 patients (3.4%) had both. Thirty-five patients (24.1%) died, including 5 (3.4%) from a cause other than their cancer. Three-year overall survival (OS), cancer specific survival, disease free survival, metastasis free survival and loco-regional free survival were respectively 78.1%, 81.3%, 67.8%, 74.5% and 88.1%. Anatomo-clinic factors predicting OS were age > 50 years (88.7 vs. 70.5%; p=0.004), diabetes history (81.2 vs. 66.7%; p=0.027), UICC N classification (100 vs. 95 vs. 77.5 vs. 68.8% respectively for N0, N1, N2 and N3; p=0.008), the practice of a lymph node biopsy (84.2 vs. 57%; p=0.05), and UICC TNM stages III-IV (93.8 vs. 73.6% respectively for stage I-II vs. III-IV; p=0.044). Therapeutic factors predicting OS were a number of CC courses (less than 4 courses: 65.8 vs. 86%; p=0.03, less than 5 courses: 71.5 vs. 89%; p=0.041), a weight loss > 10% during treatment (84.1 vs. 60.9%; p=0.021) and a total cumulative cisplatin dose, including IC and CC, < 380 mg/m² (64.4 vs. 87.6%; p=0.003). Radiotherapy delay and total duration did not significantly affect OS. No grade 3-4 late side effects were noted in the evaluable 127 patients (87.6%). The most common toxicity was dry mouth which was grade 2 in 47 cases (37%) and grade 1 in 55 cases (43.3%).Conclusion: IMRT for nasopharyngeal carcinoma granted a high loco-regional control rate for patients during the last five years. However, distant relapses remain frequent and conditionate the prognosis. We identified many anatomo-clinic and therapeutic prognosis factors. Therefore, high-risk patients require a more aggressive therapeutic approach, such as radiotherapy dose escalation or adding adjuvant chemotherapy.

Keywords: therapeutic results, prognostic factors, intensity-modulated radiotherapy, nasopharyngeal carcinoma

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Authors: Azhar Naila, Steuer Benjamin

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Over-exploitation of resources and the burden on natural systems have provoked worldwide concerns about the potential resource as well as supply risks in the future. It has been estimated that the consumption of materials and resources will double by 2060, substantially mounting the amount of waste and emissions produced by individuals, organizations, and businesses, which necessitates sustainable technological innovations to address the problem. Therefore, there is a need to design products and services purposefully for material resource efficiency. This directs us toward the conceptualization and implementation of the ‘Circular Economy (CE),’ which has gained considerable attention among policymakers, researchers, and businesses in the past decade. A large amount of literature focuses on the concept of CE. However, contextual empirical research on the need to embrace CE in an emerging economy like Pakistan is still scarce, where the traditional economic model of take-make-dispose is quite common. Textile exports account for approximately 61% of Pakistan's total exports, and the industry provides employment for about 40% of the country's total industrial workforce. The industry provides job opportunities to above 10 million farmers, with cotton as the main crop of Pakistan. Consumers, companies, as well as the government have explored very limited CE potential in the country. This gap has motivated us to carry out the present study. The study is based on a mixed method approach, for which key informant interviews have been conducted to get insight into the present situation of the ecosystem readiness for the adoption of CE in 20 textile manufacturing industries. The subject study has been conducted on the following areas i) the level of understanding of the CE concept among key stakeholders in the textile manufacturing industry ii) Companies are pushing boundaries to invest in circularity-based initiatives, exploring the depths of risk-taking iii) the current national policy framework support the adoption of CE. Qualitative assessment has been undertaken using MAXQDA to analyze the data received after the key informant interviews. The data has been transcribed and coded for further analysis. The results show that most of the key stakeholders have a clear understanding of the concept, whereas few consider it to be only relevant to the end-of-life treatment of waste generated from the industry. Non-governmental organizations have been observed to be key players in creating awareness among the manufacturing industries. Maximum companies have shown their consent to invest in initiatives related to the adoption of CE. Whereas a few consider themselves far behind the race due to a lack of financial resources and support from responsible institutions. Mostly, the industries have an ambitious vision for integrating CE into the company’s policy but seem not to be ready to take any significant steps to nurture a culture for experimentation. However, the government is not playing any vital role in the transition towards CE; rather, they have been busy with the state’s uncertain political situation. Presently, Pakistan does not have any policy framework that supports the transition towards CE. Acknowledging the present landscape a well-informed CE transition is immediately required.

Keywords: circular economy, textile supply chain, textile manufacturing industries, resource efficiency, ecosystem readiness, multi-case study analysis

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Authors: Kalpana Rajouriya, Ajay Taneja

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Particulates are ubiquitous in the air environment and cause serious threats to human beings, such as lung cancer, Chronic obstructive pulmonary disease (COPD), and Asthma. Particulates mainly arise from industrial effluent, vehicular emission, and other anthropogenic activities. In the glass industrial city Firozabad, real-time monitoring (mass as well as a number) of size segregated Particulate Matter (PM) and black carbon was done by Aerosol Black Carbon Detector (ABCD) and GRIMM portable aerosol Spectrometer at two different sites in which one site is urban, and another is rural. The average mass concentration of size segregated PM during the study period (March & April 2022) was recorded as PM₁₀ (223.73 g/m-³), PM₅.₀ (44.955 g/m-³), PM₂.₅ (59.275 g/m-³), PM₁.₀ (33.02 g/m-³), PM₀.₅ (2.05 g/m-³), and PM₀.₂₅ (2.99 g/m- ³). In number mode, PM concentration was found as PM₁₀ (27.46g/m-³), PM₅.₀ (233.48g/m-³), PM₂.₅ (646.61g/m-³), PM₁.₀ (1134.94 g/m-³), PM₀.₅ (14056.04g/m-³), and PM₀.₂₅ (182906.4 g/m-³). The highest concentration of BC was found in Urban due to the emissions from diesel engines and wood burning while NO2 was highest at the rural sites. The concentrations of PM₁₀ and PM₂.₅ exceeded the NAAQS and WHO guidelines. The sensitive, exposed population may be at risk of developing health-related problems from exposure to size-segregated PM and BC.

Keywords: particulate matter, black carbon, NO2, health risk

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Authors: Bing Lu, Shuang Li, Hongyuan Zhou

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The steel–concrete hybrid structure has been extensively employed in high–rise buildings and super high–rise buildings. The light gauge steel–concrete hybrid structure, including light gauge steel structure and concrete hybrid structure, is a new–type steel–concrete hybrid structure, which possesses some advantages of light gauge steel structure and concrete hybrid structure. The seismic behavior and loss assessment of three high–rise buildings with three different concrete hybrid structures were investigated through finite element software, respectively. The three concrete hybrid structures are reinforced concrete column–steel beam (RC‒S) hybrid structure, concrete–filled steel tube column–steel beam (CFST‒S) hybrid structure, and tubed concrete column–steel beam (TC‒S) hybrid structure. The nonlinear time-history analysis of three high–rise buildings under 80 earthquakes was carried out. After simulation, it indicated that the seismic performances of three high–rise buildings were superior. Under extremely rare earthquakes, the maximum inter–storey drifts of three high–rise buildings are significantly lower than 1/50. The inter–storey drift and floor acceleration of high–rise building with CFST‒S hybrid structure were bigger than those of high–rise buildings with RC‒S hybrid structure, and smaller than those of high–rise building with TC‒S hybrid structure. Then, based on the time–history analysis results, the post-earthquake repair cost ratio and repair time of three high–rise buildings were predicted through an economic performance analysis method proposed in FEMA‒P58 report. Under frequent earthquakes, basic earthquakes and rare earthquakes, the repair cost ratio and repair time of three high-rise buildings were less than 5% and 15 days, respectively. Under extremely rare earthquakes, the repair cost ratio and repair time of high-rise buildings with TC‒S hybrid structure were the most among three high rise buildings. Due to the advantages of CFST-S hybrid structure, it could be extensively employed in high-rise buildings subjected to earthquake excitations.

Keywords: seismic behavior, loss assessment, light gauge steel–concrete hybrid structure, high–rise building, time–history analysis

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Authors: Emmanuelle Maria, Pierre Crançon, Gaëtane Lespes

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The knowledge of uranium migration processes within underground environments is a major issue in the environmental risk assessment associated with nuclear activities. This process is identified as strongly controlled by adsorption mechanisms, thus leading to strongly delayed migration paths. Colloidal ligands are likely to significantly increase the mobility of uranium in natural environments. The ability of colloids to mobilize and transport uranium depends on their origin, their nature, their structure, their stability and their reactivity with uranium. Thus, the colloidal mobilization and transport properties are often described as site-specific. In this work, the colloidal phases of two leachates obtained from two different horizons of the same podzolic soil were characterized with a speciation approach. For this purpose, a multi-technique strategy was used, based on Field-Flow Fractionation coupled to Ultraviolet, Multi-Angle Light Scattering and Inductively Coupled Plasma Mass Spectrometry (AF4-UV-MALS-ICPMS), Transmission Electron Microscopy (TEM), Electrospray Ionization Orbitrap Mass Spectrometry (ESI-Orbitrap), and Time-Resolved Laser Fluorescence Spectroscopy (TRLFS-EEM). Thus, elemental composition, size distribution, microscopic structure, colloidal stability and possible organic and/or inorganic content of colloids were determined, as well as their association with uranium. The leachates exhibit differences in their physical and chemical characteristics, mainly in the nature of organic matter constituents. The multi-technique investigation strategy used provides original data about colloidal phase structure and composition, offering a new vision of the way the uranium can be mobilized and transported in the considered soil. This information is a real significant contribution opening the way to our understanding and predicting of the colloidal transport.

Keywords: colloids, migration, multi-technique, speciation, transport, uranium

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Authors: Jaypalsinh B. Parmar, Pintu Nakrani, Ashish Chaurasia

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Digital Elevation Model (DEM) is considered as an important data in GIS-based terrain analysis for many applications and assessment of processes such as environmental and climate change studies, hydrologic modelling, etc. Vertical accuracy of DEM having geographically dynamic nature depends on different parameters which affect the model simulation outcomes. Vertical accuracy assessment in Indian landscape especially in low-lying coastal urban terrain such as lower Tapi Basin is very limited. In the present study, attempt has been made to evaluate the vertical accuracy of 30m resolution open source Indian National Cartosat-1 DEM v3 for Lower Tapi Basin (LTB) from western India. The extensive field investigation is carried out using stratified random fast static DGPS survey in the entire study region, and 117 high accuracy ground control points (GCPs) have been obtained. The above open source DEM was compared with obtained GCPs, and different statistical attributes were envisaged, and vertical error histograms were also evaluated.

Keywords: CartoDEM, Digital Elevation Model, GPS, lower Tapi basin

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Authors: Shu-Ching Chiu, Shu-Fang Chang

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The World Health Organization (WHO) has been actively developing intervention programs to deal with geriatric frailty. In its White Paper on Healthcare Policy 2020, the Department of Health, Bureau of Health Promotion proposed that active aging and the prevention of disability are essential for elderly people to maintain good health. The paper recommended five main policies relevant to this objective, one of which is the prevention of frailty and disability. Scholars have proposed a number of different criteria to diagnose and assess frailty; no consistent or normative standard of measurement is currently available. In addition, many methods of assessment are recursive, which can easily result in recall bias. Due to the relationship between frailty and physical fitness with regard to co-morbidity, it is important that academics optimize the criteria used to assess frailty by objectively evaluating the physical fitness of senior citizens. This study used a review of the literature to identify fitness indicators suitable for measuring frailty in the elderly. This study recommends that measurement criteria be integrated to produce an optimized predictive value for frailty score. Healthcare professionals could use this data to detect frailty at an early stage and provide appropriate care to prevent further debilitation and increase longevity.

Keywords: frailty, aging, physical fitness, optimized criteria, healthcare

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Authors: Mohamed Alzarug Aburugba, Rashid Mohamed Eltanashi

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Rainwater is considered an essential water resource, as it contributes to filling the deficit in water resources, especially in countries that suffer from a scarcity of natural water sources. One of the important issues facing the Water and Gas Services Department at the Libyan Iron and Steel Company is the large loss of quantities of industrial water, both direct and indirect cooling water (DCW, ICW), produced within the company due to leaks in the cooling systems of the factories of the Libyan Iron and Steel Company. These amounts of polluted industrial water leakage are mixed with rainwater collected by stormwater stations (6 stations) in LISCO, which is pumped to the sea through pumps with a very high flow rate, and thus, this will carry a lot of waste, heavy metals, and oils to the sea, which negatively affects marine environmental resources. This paper assesses the environmental impact of the quantities of rainwater and mixed industrial water in stormwater stations in the Libyan Iron and Steel Company and methods of mitigation, treating pollutants and reusing them as industrial water in the production processes of the steel industry.

Keywords: rainwater, mitigation, impact, sewage, heavy metals, assessment, pollution, environment, natural resources, industrial water.

Procedia PDF Downloads 64

Authors: Jesha Faye T. Librea, Leslie Joy L. Diaz

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Fuel-derived rice husk ash (fRHA) is a waste material from industries employing rice husk as a biomass fuel which, on the downside, causes disposal and environmental problems. To mitigate this, the fRHA was evaluated for use in other applications such as a pozzolanic material for the construction industry. In this study, the assessment of the potential of fRHA as pozzolanic supplementary cementitious material was conducted by determining the chemical and physical properties of fRHA according to ASTM C618, evaluating the fineness of the material according to ASTM C430, and determining its pozzolanic activity using Luxan Method. The material was found to have a high amorphous silica content of around 95.82 % with traces of alkaline and carbon impurities. The retained carbon residue is 7.18 %, which is within the limit of the specifications for natural pozzolans indicated in ASTM C618. The fineness of the fRHA is at 88.88 % retained at a 45-micron sieve, which, however, exceeded the limit of 34 %. This large particle size distribution was found to affect the pozzolanic activity of the fRHA. This was shown in the Luxan test, where the fRHA was identified as non-pozzolan due to its low pozzolanic activity index of 0.262. Thus, further processing must be done to the fRHA to pass the required ASTM fineness, have a higher pozzolanic activity index, and fully qualify as a pozzolanic material.

Keywords: rice husk ash, pozzolanic, fuel-derived ash, supplementary cementitious material

Procedia PDF Downloads 66

Authors: R. Lhissou , A. El Harti , K. Chokmani, E. Bachaoui, A. El Ghmari

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Soil salinity is a serious environmental hazard in many countries around the world especially the arid and semi-arid countries like Morocco. Salinization causes negative effects on the ground; it affects agricultural production, infrastructure, water resources and biodiversity. Remote sensing can provide soil salinity information for large areas, and in a relatively short time. In addition, remote sensing is not limited by extremes in terrain or hazardous condition. Contrariwise, experimental methods for monitoring soil salinity by direct measurements in situ are very demanding of time and resources, and also very limited in spatial coverage. In the irrigated perimeter of Tadla plain in central Morocco, the increased use of saline groundwater and surface water, coupled with agricultural intensification leads to the deterioration of soil quality especially by salinization. In this study, we assessed several spectral indices of soil salinity cited in the literature using Landsat TM satellite images and field measurements of electrical conductivity (EC). Three Landsat TM satellite images were taken during 3 months in the dry season (September, October and November 2011). Based on field measurement data of EC collected in three field campaigns over the three dates simultaneously with acquisition dates of Landsat TM satellite images, a two assessment techniques are used to validate a soil salinity spectral indices. Firstly, the spectral indices are validated locally by pixel. The second validation technique is made using a window of size 3x3 pixels. The results of the study indicated that the second technique provides getting a more accurate validation and the assessment has shown its limits when it comes to assess across the pixel. In addition, the EC values measured from field have a good correlation with some spectral indices derived from Landsat TM data and the best results show an r² of 0.88, 0.79 and 0.65 for Salinity Index (SI) in the three dates respectively. The results have shown the usefulness of spectral indices as an auxiliary variable in the spatial estimation and mapping salinity in irrigated land.

Keywords: remote sensing, spectral indices, soil salinity, irrigated land

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Authors: Haftay Abraha Tadesse, Atsebaha Gebrekidan Kahsay, Mahumd Abdulkader

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Background: Salmonella species and Escherichia coli are important foodborne pathogens affecting humans and animals. They are among the most important causes of infection that are associated with the consumption of contaminated food. This study was aimed to determine the prevalence, antimicrobial susceptibility patterns and associated risk factors for Salmonella species and E. coli in raw meat from butchery houses of Mekelle, Northern Ethiopia. Methodology: A cross-sectional study was conducted from January to September 2019. Socio-demographic data and risk factors were collected using a predesigned questionnaire. Meat samples were collected aseptically from the butchery houses and transported using icebox to Mekelle University, College of Veterinary Sciences for the isolation and identification of Salmonella species and E. coli, Antimicrobial susceptibility patterns were determined using Kirby disc diffusion method. Data obtained were cleaned and entered into Statistical Package for the Social Sciences version 22 and logistic regression models with odds ratio were calculated. P-value < 0.05 was considered as statistically significant. Results: A total of 153 out of 384 (39.8%) of the meat specimens were found to be contaminated. The contamination of Salmonella species and E. coli were 15.6% (n=60) and 20.8%) (n=80), respectively. Mixed contamination (Salmonella species and E. coli) was observed in 13 (3.4 %) of the analyzed. Poor washing hands regularly (AOR = 8.37; 95% CI: 2.75-25.50) and not using gloves during meat handling (AOR=11. 28; 95% CI: (4.69 27.10) were associated with an overall bacterial contamination.About 95.5% of the tested isolates were sensitive to chloramphenicol and norfloxacin while the resistance of amoxyclav_amoxicillin and erythromycin were both isolated bacteria species. The overall multidrug resistance pattern for Salmonella and E. coli were 51.4% (n=19) and 31.8% (14), respectively. Conclusion: Of the 153 (153/384) contaminated raw meat, 60 (15.6%) and 80 (20.8%) were contaminated by Salmonella species and E. coli, respectively. Poor hand washing practice and not using glove during meat handling showed significant association with bacterial contamination. Multidrug-resistant showed in Salmonella species and E. coli were 19 (51.4%) and 14 (31.8%), respectively.

Keywords: antimicrobial susceptibility test, butchery houses, e. coli, salmonella species

Procedia PDF Downloads 52

Authors: Paria Koraei, Meysam Ahmadzadeh, Reza Shahriarirad, Keivan Ranjbar, Farzane Farahmand

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The rapid spread of the coronavirus disease 2019 (COVID-19) has enlisted dental offices in high-risk places. A cross-sectional survey was carried out among the general population aged 17 and above in Shiraz, Fars, Iran. The patients' demographic features were recorded and analyzed against questions regarding fear, anxiety, and attitude toward dental appointments. The Dental Anxiety Scale (DAS) questionnaire was used for the evaluation of anxiety levels. Among a total of 760 participants, the average age was 32.33±11.27 years, while 242 (31.8%) were male and 357 (47%) were single. Based on the anxiety scores, 336 (44.2%) participants had mild anxiety, 215 (28.3%) had moderate anxiety, 74 (9.7%) had high, and 135 (17.8%) had severe anxiety. The majority of participants used masks (93.8%) and disinfectants (79.9%) during dental visits, and the most emphasized policies during dental visits were using disposable face masks by the personnel (83.6%) and controlling the number of visitors in the office (81.8%). Only 226 (29.7%) reported that they hadn’t postponed their dental visits. Our findings demonstrated that anxiety in people increases toward dental treatments during the COVID-19 pandemic, resulting in decreased dental appointments. Dentally anxious people were more likely to be female and married couples. Being female and older age are possible risk factors for developing a fear of dental procedures.

Keywords: Covid-19, anxiety, fear, dentistry, dental care

Procedia PDF Downloads 92

Authors: Lily Parm, Irma Nool, Liina Männiksaar, Mare Tupits, Ivi Prits, Merilin Kuhi, Valentina Raudsepp

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Background: The results of previous clinical satisfaction surveys show that nursing students swhounderw entinternships in the pediatricwardhadthelowestsatisfactioncomparedtootherwards, but the quality of students' practicaltrainingexperienceisanimportant determinant in nursing education. The aim of theresearchwastodescribenursingstudents` assessment to the clinical learning environment and supervision in pediatric wards Method: Theresearchisquantitative. All studentswhohadpracticaltraining in the pediatric ward participated in the study (N = 39). FordatacollectionClinicalLearningEnvironment, Supervision, and NurseTeacher (CLES + T) evaluationscalewasused, wherethescalewasanswered on a 5-point Likert scale. In addition, 10 backgroundvariableswereused in the questionnaire. IBM SPSS Statistics 28.0 wasusedfordataanalysis. Descriptive statistics and Spearmanncorrelationanalysiswasusedtofindcorrelatinsbetweenbackgroundvariables and satisfaction with supervision.Permissiontoconductthestudy (No 695) hasbeenobtainedbytheEthicsCommittee of theInstituteforHealthDevelopment. Results: Of therespondents, 28 (71.8%) werefirst-year, 9 (23.1%) second-year and 2 (5.1%) fourth-yearstudents. Thelargestshare of the last practicaltrainigwas in nursing, with 27 (69.2%) respondents. Mainlythementorswerenursesfor 32 (82,1%) of students.Satisfactionwiththementoring (4.4 ± 0.83) and wardnursemanager`sleaderhiostyle (4.4 ± 0.7), ratedthehighest and therole of thenurseteacherwasratedthelowest (3,7 ± 0.83.In Spearmann'scorrelationanalysis, therewas a statisticallystrongcorrelationbetween a positiveattitudetowardsthesupervisor'ssupervision and receivingfeedbackfromthesupervisor (r =0.755; p <0.001), studentsatisfactionwithsupervision (r = 0.742; p <0.001), supervisionbased on cooperation (r = 0.77) and instructionbased on theprinciple of equalitythatpromotedlearning (r = 0.755; p <0.001). Conclusions: Theresults of theresearchshowedhighsatisfactionwiththesupervisionand therole of wardmanager. Stillbettercooperationisneededbetweenpracticalplacement and nursingschooltoenhancethestudents`satisfactionwithsupervision.

Keywords: CLES+T, clinical environment, nurse teacher, statisfaction, pediatric ward, mentorship

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Authors: Abraham Rotich

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The purpose of this study was to determine the effects of relationship banking on the financial performance of SMEs. The paper attempted to establish the link between the constructs of relationship banking and SME performance. The study was guided by relationship lending, relationship monitoring, relationship risk sharing and bundle of products as independent variables while financial performance will be the dependent variable. The study used a quasi experimental design with population being the 620 SMEs who have a relationship banking arrangement with banks in Nairobi. The study used stratified sampling to pick a sample of 235. The population of interest will be the CEOs of the respective companies. The basis of stratification is the sectors in which the SMEs operate in. The study will use a questionnaire to collect data. The questionnaire will have both open and close ended questions. A pilot study will be conducted to test reliability and validity of questionnaire. The data was analyzed using descriptive statistics. Regression analysis was employed to test if there is a relationship between the dependent and the independent variable. The study found evidence that relationship banking positively impacts on financial performance of SMEs. Specifically, the study established that each component of relationship banking in this study i.e relationship lending, monitoring, bundle of products and risk sharing positively affects financial performance.

Keywords: relationship banking, SMEs, financial performance, entrepreneurial orientation

Procedia PDF Downloads 323

Authors: Vinodhini Elangovan, Jen Heng Pek

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Background: An ectopic pregnancy is defined as any pregnancy implanted outside of the endometrial cavity. Cornual pregnancy, a rare variety of ectopic pregnancies, is seen in about 2-4% of ectopic pregnancies. It develops in the interstitial portion of the fallopian tube and invades through the uterine wall. This case describes a third-trimester cornual pregnancy that resulted in a uterine rupture. Case: A 38-year old Chinese lady was brought to the Emergency Department (ED) as a standby case for hypotension. She was 30+6 weeks pregnant (Gravida 3, Parous 1). Her past obstetric history included a live birth delivered via lower segment Caesarean section due to non-reassuring fetal status in 2002 and a miscarriage in 2012. She developed generalized abdominal pain. There was no per vaginal bleeding or leaking liquor. There was also no fever, nausea, vomiting, constipation, diarrhea, or urinary symptoms. On arrival in the ED, she was pale, diaphoretic, and lethargic. She had generalized tenderness with guarding and rebound over her abdomen. Point of care ultrasound was performed and showed a large amount of intra-abdominal free fluid, and the fetal heart rate was 170 beats per minute. The point of care hemoglobin was 7.1 g/dL, and lactate was 6.8 mmol/L. The patient’s blood pressure dropped precipitously to 50/36 mmHg, and her heart rate went up to 141 beats per minute. The clinical impression was profound shock secondary to uterine rupture. Intra-operatively, there was extensive haemoperitoneum, and the fetus was seen in the abdominal cavity. The fetus was delivered immediately and handed to the neonatal team. On exploration of the uterus, the point of rupture was at the left cornual region where the placenta was attached to. Discussion: Cornual pregnancies are difficult to diagnose pre-operatively with low ultrasonographic sensitivity and hence are commonly confused with normal intrauterine pregnancies. They pose a higher risk of rupture and hemorrhage compared to other types of ectopic pregnancies. In very rare circumstances, interstitial pregnancies can result in a viable fetus. Uterine rupture resulting in hemorrhagic shock is a true obstetric emergency that can result in significant morbidity and mortality for the patient and the fetus, and early diagnosis in the emergency department is crucial. The patient in this case presented with known risk factors of multiparity, advanced maternal age, and previous lower segment cesarean section, which increased the suspicion of uterine rupture. Ultrasound assessment may be beneficial to any patient who presents with symptoms and a history of uterine surgery to assess the possibility of uterine dehiscence or rupture. Management of a patient suspected of uterine rupture should be systematic in the emergency department and follow an ABC approach. Conclusion: This case demonstrates the importance for an emergency physician to maintain the suspicion for ectopic pregnancy even at advanced gestational ages. It also highlights how even though all emergency physicians may not be qualified to do a detailed pelvic ultrasound, it is essential for them to be competent with a point of care ultrasound to make a prompt diagnosis of conditions such as uterine rupture.

Keywords: cornual ectopic , ectopic pregnancy, emergency medicine, obstetric emergencies

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Authors: Gideon Baffoe, Hirotaka Matsuda

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Rural livelihood systems are known to be inherently vulnerable. Attempt to reduce vulnerability is linked to developing resilience to both internal and external shocks, thereby increasing the overall sustainability of livelihood systems. The shocks and stresses could be induced by natural processes such as the climate and/or by social dynamics such as institutional failure. In this wise, livelihood vulnerability is understood as a combined effect of biophysical, economic, and social processes. However, previous empirical studies on livelihood vulnerability in the context of rural areas across the globe have tended to focus more on climate-induced vulnerability assessment with few studies empirically partially considering the multiple dimensions of livelihood vulnerability. This has left a gap in our understanding of the subject. Using the Livelihood Vulnerability Index (LVI), this study aims to comprehensively assess the livelihood vulnerability level of rural households using Ehiamenkyene, a community in the forest zone of Eastern Ghana as a case study. Though the present study adopts the LVI approach, it differs from the original framework in two respects; (1) it introduces institutional influence into the framework and (2) it appreciates the gender differences in livelihood vulnerability. The study utilized empirical data collected from 110 households’ in the community. The overall study results show a high livelihood vulnerability situation in the community with male-headed households likely to be more vulnerable than their female counterparts. Out of the seven subcomponents assessed, only two (socio-demographic profile and livelihood strategies) recorded low vulnerability scores of less than 0.5 with the remaining five (health status, food security, water accessibility, institutional influence and natural disasters and climate variability) recording scores above 0.5, with institutional influence being the component with the highest impact score. The results suggest that to improve the livelihood conditions of the people; there is the need to prioritize issues related to the operations of both internal and external institutions, health status, food security, water and climate variability in the community.

Keywords: assessment, gender, livelihood, rural, vulnerability

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