Search results for: birth weight

Authors: Shuangxin Wu

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Superalloy ultra-thin-walled components occupy a considerable proportion of aero engines and play an increasingly important role in structural weight reduction and performance improvement. To solve problems such as high deformation resistance and poor formability at room temperature, the introduction of pulse current in the processing process can improve the plasticity of metal materials, but the influence mechanism of pulse current on the forming limit of superalloy ultra-thin sheet is not clear, which is of great significance for determining the material processing window and improving the micro-forming process. The effect of pulse current on the microstructure evolution of superalloy thin plates was observed by optical microscopy (OM) and X-ray diffraction topography (XRT) by applying pulse current to GH3039 with a thickness of 0.2mm under plane strain and uniaxial tensile states. Compared with the specimen without pulse current applied at the same temperature, the internal void volume fraction is significantly reduced, reflecting the non-thermal effect of pulse current on the growth of micro-pores. ED (electrically deforming) specimens have larger and deeper dimples, but the elongation is not significantly improved because the pulse current promotes the void coalescence process, resulting in material fracture. The electro-plastic phenomenon is more obvious in the plane strain state, which is closely related to the effect of stress triaxial degree on the void evolution under pulsed current.

Keywords: pulse current, superalloy, ductile fracture, void damage

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Authors: Emrah Yaliniz, Ali Kalkanli

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ZE41A magnesium alloy has been extensively used in aerospace industry, especially for use in rotorcraft transmission casings. Due to the improved mechanical properties, the latest generation of magnesium casting alloy EV31A-T6 (Elektron 21® specified in AMS 4429) is seen as a potential replacement for ZE41A in terms of strength. Therefore, the necessity of enhancement has been arisen for ZE41A in order to avoid fully replacement. The main element affecting the strength of ZE41A is Zirconium (Zr), which acts as a grain refiner. The specified range of Zr element for ZE41A alloy is between 0.4 wt % and 1.0 wt % (unless otherwise stated by weight percentage after this point) as stated in AMS 4439. This paper investigates the effects of Zr amount on tensile and metallurgical properties of ZE41A magnesium alloy. The Zr alloying amount for the research has been chosen as 0.5 % and 1 %, which are standard amounts in a commercial alloy (average of 0.4-0.6%) and maximum percent in the standard, separately. 1 % Zr amount has been achieved via Zirmax (66.7 Mg-33.3 Zr) master alloy addition. The ultimate tensile strength of ZE41A with 1% Zr has been increased up to about 220-225 MPa in comparison to 200 MPa given in AMS 4439. The reason for the increase in strength with the addition of Zirmax is based on the decrease in grain size, which was measured about 30 µm. Optical microscope, scanning electron microscopy (SEM) and X-ray Diffraction (XRD) were used to detect the change in the microstructural futures via alloying. The zirconium rich coring at the center of the grains was observed in addition to the grain boundary intermetallic phases and bulk Mg-rich matrix. The solidification characteristics were also identified by using the cooling curve obtained from the sand casting mold during cooling of the alloys.

Keywords: aerospace, grain refinement, magnesium, sand casting, ZE41A

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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: M. Zadshakoyan, H. Marassem Bonab, P. M. Keshtiban

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The SPD process widely used to optimize microstructure, strength and mechanical properties of the metals. Processes such as ARB and APB could have a considerable impact on improving the properties of metals. The aluminum material after steel, known as the most used metal, Because of its low strength, there are restrictions on the use of this metal, it is required to spread further studies to increase strength and improve the mechanical properties of this light weight metal. In this study, Annealed aluminum material, with yield strength of 85 MPa and tensile strength of 124 MPa, sliced into 2 sheets with dimensions of 30 and 25 mm and the thickness of 1.5 mm. then the sheets press bonded under 6 cycles, which increased the ultimate strength to 281 MPa. In addition, by adding 0.1%Wt of SiC particles to interface of the sheets, the sheets press bonded by 6 cycles to achieve a homogeneous composite. The same operation using Al2O3 particles and a mixture of SiC+Al2O3 particles was repeated and the amount of strength and elongation of produced composites compared with each other and with pure 6 cycle press bonded Aluminum. The results indicated that the ultimate strength of Al/SiC composite was 2.6 times greater than Annealed aluminum. And Al/Al2O3 and Al/Al2O3+SiC samples were low strength than Al/SiC sample. The pure 6 time press bonded Aluminum had lowest strength by 2.2 times greater than annealed aluminum. Strength of aluminum was increased by making the metal matrix composite. Also, it was found that the hardness of pure Aluminum increased 1.7 times after 6 cycles of APB process, hardness of the composite samples improved further, so that, the hardness of Al/SiC increased up to 2.51 times greater than annealed aluminum.

Keywords: APB, nano composite, nano particles, severe plastic deformation

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Authors: Mohamad Nizam Asmuni, Ahmad Naszeri Salleh, Yunus Adam, Azhar Yaacob, Mohd Hafiz Rosli, Muhamad Nazrul Hakim Abdullah

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Physical Education teacher at the school should have good physical fitness to educate and guide students in the school. Currently, there are no standards for the level of physical fitness for teachers who teaches physical education at the school. Therefore, this research is to determine the level of physical fitness of teacher of Physical Education at Maktab Rendah Sains MARA (MRSM). A total of 28 samples (18 men and 10 women, age 33 ± 4.91), teachers of physical education at MRSM, were randomly selected to participate in this study. Height, weight, body fat percentage, body mass index (BMI) and other physical testing are measured and recorded. The results showed that the average of body mass index (BMI) for teachers of Physical Education is 25.9 ± 4:57. Body mass index (BMI) of teachers can be categorized as pre-obese based on World Health Organization (WHO) guidelines. Body fat percentage for male (age; 34.3 ± 5.13) and female (age; 30.9 ± 3.81) teachers is 24.7% ± 6.54 and 30.6% ± 6.28, respectively. Male teachers were categorized as overfat, however, female teachers were categorized as healthy based on body fat ranges for standard adults at NY Obesity Research Center. Bleep test results show that the average Bleep test is level 4 and shuttle 2; average VO2max was 27.5 ± 5.94 L/min. Physical fitness and performance of physical education teachers at MRSM is much lower compared to the rugby junior athlete in University Putra Malaysia (UPM). Therefore, physical fitness of teachers must be improved to ensure the physical education classes at MRSM could be done better.

Keywords: physical fitness, BMI, bleep test, obesity

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Authors: Malleshappa Japagal, Srinivas Chitragar

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The use of waste plastic in pavement is becoming important alternative worldwide for disposal of plastic as well as to improve the stability of pavement and to meet out environmental issues. However, there are still concerns on fatigue and fracture resistance of Hot Mix Asphalt with the addition of plastic waste, (HMA-Plastic mixes) and moisture damage potential. The present study was undertaken to evaluate fracture resistance of HMA-Plastic mixes using semi-circular bending (SCB) test and moisture damage potential by Indirect Tensile strength (ITS) test using retained tensile strength (TSR). In this study, a dense graded asphalt mix with 19 mm nominal maximum aggregate size was designed in the laboratory using Marshall Mix design method. Aggregates were coated with different percentages of waste plastic (0%, 2%, 3% and 4%) by weight of aggregate and performance evaluation of fracture resistance and Moisture damage was carried out. The following parameters were estimated for the mixes: J-Integral or Jc, strain energy at failure, peak load at failure, and deformation at failure. It was found that the strain energy and peak load of all the mixes decrease with an increase in notch depth, indicating that increased percentage of plastic waste gave better fracture resistance. The moisture damage potential was evaluated by Tensile strength ratio (TSR). The experimental results shown increased TRS value up to 3% addition of waste plastic in HMA mix which gives better performance hence the use of waste plastic in road construction is favorable.

Keywords: hot mix asphalt, semi circular bending, marshall mix design, tensile strength ratio

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Authors: Samet Aktaş, Nurtekin Erkmen, Faruk Guven, Halil Taskin

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This study aimed to determine the effects of 3 versus 3 small-sided games (SSG) with different recovery times on soma physiological parameters in soccer players. Twelve soccer players from Regional Amateur League volunteered for this study (mean±SD age, 20.50±2.43 years; height, 177.73±4.13 cm; weight, 70.83±8.38 kg). Subjects were performing soccer training for five days per week. The protocol of the study was approved by the local ethic committee in School of Physical Education and Sport, Selcuk University. The subjects were divided into teams with 3 players according to Yo-Yo Intermittent Recovery Test. The field dimension was 26 m wide and 34 m in length. Subjects performed two times in a random order a series of 3 bouts of 3-a-side SSGs with 3 min and 5 min recovery durations. In SSGs, each set were performed with 6 min duration. The percent of maximal heart rate (% HRmax), blood lactate concentration (LA) and Rated Perceived Exertion (RPE) scale points were collected before the SSGs and at the end of each set. Data were analyzed by analysis of variance (ANOVA) with repeated measures. Significant differences were found between %HRmax in before SSG and 1st set, 2nd set, and 3rd set in both SSG with 3 min recovery duration and SSG with 5 min recovery duration (p<0.05). Means of %HRmax in SSG with 3 min recovery duration at both 1st and 2nd sets were significantly higher than SSG with 5 min recovery duration (p<0.05). No significant difference was found between sets of either SSGs in terms of LA (p>0.05). LA in SSG with 3 min recovery duration was higher than SSG with 5 min recovery duration at 2nd sets (p<0.05). RPE in soccer players was not different between SSGs (p>0.05).In conclusion, this study demonstrates that exercise intensity in SSG with 3 min recovery durations is higher than SSG with 5 min recovery durations.

Keywords: small-sided games, soccer, heart rate, lactate

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Authors: Ziad Abdeldayem, Jakub Markiewicz, Kunal Kansara, Laura Edwards

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Airborne Laser Scanning (ALS) is one of the main technologies for generating high-resolution digital terrain models (DTMs). DTMs are crucial to several applications, such as topographic mapping, flood zone delineation, geographic information systems (GIS), hydrological modelling, spatial analysis, etc. Laser scanning system generates irregularly spaced three-dimensional cloud of points. Raw ALS data are mainly ground points (that represent the bare earth) and non-ground points (that represent buildings, trees, cars, etc.). Removing all the non-ground points from the raw data is referred to as filtering. Filtering heavily forested areas is considered a difficult and challenging task as the canopy stops laser pulses from reaching the terrain surface. This research presents an approach for removing non-ground points from raw ALS data in densely forested areas. Smoothing splines are exploited to interpolate and fit the noisy ALS data. The presented filter utilizes a weight function to allocate weights for each point of the data. Furthermore, unlike most of the methods, the presented filtering algorithm is designed to be automatic. Three different forested areas in the United Kingdom are used to assess the performance of the algorithm. The results show that the generated DTMs from the filtered data are accurate (when compared against reference terrain data) and the performance of the method is stable for all the heavily forested data samples. The average root mean square error (RMSE) value is 0.35 m.

Keywords: airborne laser scanning, digital terrain models, filtering, forested areas

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Authors: Malgorzata Walkowiak, Magdalena Witczak, Wojciech Cichy

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Biomass is an important renewable energy source in Poland. As a biofuel, it has many advantages like renewable in noticeable time and relatively high energy potential. But disadvantages of biomass like high moisture content and hygroscopic nature causes that gaining, transport, storage and preparation for combustion become troublesome and uneconomic. Thermal modification of biomass can improve hydrophobic properties, increase its calorific value and natural resistance. This form of thermal processing is known as torrefaction. The aim of the study was to investigate the effect of the pre-heat treatment of wood and plant lignocellulosic raw materials on the properties of solid biofuels. The preliminary studies included pine, beech and willow wood and other lignocellulosic raw materials: mustard, hemp, grass stems, tobacco stalks, sunflower husks, Miscanthus straw, rape straw, cereal straw, Virginia Mallow straw, rapeseed meal. Torrefaction was carried out using variable temperatures and time of the process, depending on the material used. It was specified the weight loss and the ash content and calorific value was determined. It was found that the thermal treatment of the tested lignocellulosic raw materials is able to provide solid biofuel with improved properties. In the woody materials, the increase of the lower heating value was in the range of 0,3 MJ/kg (pine and beech) to 1,1 MJ/kg (willow), in non-woody materials – from 0,5 MJ/kg (tobacco stalks, Miscanthus) to 3,5 MJ/kg (rapeseed meal). The obtained results indicate for further research needs, particularly in terms of conditions of the torrefaction process.

Keywords: biomass, lignocellulosic materials, solid biofuels, torrefaction

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Authors: Feny Acelia Silaban

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The development of Indonesia’s infrastructure in many islands is significantly increased through the years. Based on this condition, concrete materials which are extracted from natural resources are over exploited and slowly becoming rare, thus the demand for alternative materials becomes so urgently crucial. Oil Palm is one of the biggest commodities in Indonesia with the total amount of 31 million tons in the last 2014. The production of palm oil also generates lots of solid wastes in the form of Oil Palm Shell (OPS). Constructing more environmentally sustainable structures can be achieved by producing lightweight concrete using the Oil Palm Shell (OPS). This paper investigated the effects of OPS and combination of Superplasticizer and fly ash proportion of lightweight concrete mix design to the compressive strength, flexure strength, modulus of elasticity, shrinkage behavior, and water absorption. The Oil Palm Shell had undergone special treatment by washing it with hot water and soap to reduce the oil content. This experiment used four different proportions of Superplasticizer with fly ash and 30 % OPS proportion from the weight of total compositions mixture by the result of trial mix. The experiment result showed that using OPS coarse aggregates and Superplasticizer with fly ash, the average of 28-day compressive strength reached 30-35 MPa. The highest 28-day compressive strength comes from 1.2 % Superplasticizer with 5 % fly ash proportion samples with the strength by 33 MPa. The sample with proportion of 1 % Superplasticizer and 7.5 % fly ash has the highest shrinkage value compared to other proportions. The characteristic of OPS as coarse aggregates is in a standard range of natural coarse aggregates. In general, this lightweight concrete using OPS coarse aggregate and Superplasticizer has high potential to be green-structural lightweight concrete alternative in Indonesia.

Keywords: lightweight concrete, oil palm shell, waste materials, superplasticizer

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Authors: A. Abbas Khalaf, L. Issazadeh, Z. Arif Abdullah, J. Hassanpour

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In order to evaluate the growth and yield properties of two Sorghum-Sudangrass hybrids under different irrigation levels, an investigation was done in the experiment site of Collage of Agriculture, University of Duhok, Kurdistan region of Iraq (36°5´38^⸗ N, 42°52´02^⸗ E) in the years 2015-16. The experiment was conducted under Randomized Complete Block Design (RCBD) with three replications, which main factor was irrigation treatments (I₁₀₀, I₇₅ and I₅₀) according to evaporation pan class A and type of Sorghum-Sudangrass hybrids (KH12SU9001, G₁) and (KH12SU9002, G₂) were factors of subplots. The parameters studied were: plant height (cm), number of green leaves per plant; leaf area (m²/m²), stem thickness (mm), percent of protein, fresh and dry biomass (ton.ha^-1) and also crop water productivity. The results of variance analysis showed that KH12SU9001 variety had more amount of leaf area, percent of protein, fresh and dry biomass yield in comparison to KH12SU9002 variety. By comparing effects of irrigation levels on vegetative growth and yield properties, results showed that amount of plant height, fresh and dry biomass weight was decreased by decreasing irrigation level from full irrigation regime to 5 _o% of irrigation level. Also, results of crop water productivity (CWP) indicated that improvement in quantity of irrigation would impact fresh and dry biomass yield significantly. Full irrigation regime was recorded the highest level of CWP (1.28-1.29 kg.m^-3).

Keywords: deficit irrigation, growth, sorghum-sudangrass hybrid, yield

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Authors: Nataša Stojić, Mira Pucarević, Nebojša Ralević, Vojislava Bursić, Gordan Stojić

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Surface soil (0 – 10 cm) samples from 52 sampling sites along the length of railway tracks on the territory of Srem (the western part of the Autonomous Province of Vojvodina, itself part of Serbia) were collected and analyzed for 7 polychlorinated biphenyls (PCBs) in order to see how the distance from the railroad on the one hand and dump on the other hand, affect the concentration of PCBs (CPCBs) in the soil. Samples were taken at a distance of 0.03 to 4.19 km from the railway and 0.43 to 3.35 km from the landfills. For the soil extraction the Soxhlet extraction (USEPA 3540S) was used. The extracts were purified on a silica-gel column (USEPA 3630C). The analysis of the extracts was performed by gas chromatography with tandem mass spectrometry. PCBs were not detected only at two locations. Mean total concentration of PCBs for all other sampling locations was 0,0043 ppm dry weight (dw) with a range of 0,0005 to 0,0227 ppm dw. On the part of the data that were interesting for this research with statistical methods (PCA) were isolated factors that affect the concentration of PCBs. Data were also analyzed using the Pearson's chi-squared test which showed that the hypothesis of independence of CPCBs and distance from the railway can be rejected. Hypothesis of independence between CPCB and the percentage of humus in the soil can also be rejected, in contrast to dependence of CPCB and the distance from the landfill where the hypothesis of independence cannot be rejected. Based on these results can be said that railway transport is a potential source of PCBs. The next step in this research is to establish the position of transformers which are located near sampling sites as another important factor that affects the concentration of PCBs in the soil.

Keywords: GC/MS, landfill, PCB, railway, soil

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Authors: Pawit Tangviroon, Apichit Svang-Ariyaskul

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As the limited availability of petroleum-based fuel has been a major concern, biodiesel is one of the most attractive alternative fuels because it is renewable and it also has advantages over the conventional petroleum-base diesel. At Present, productions of biodiesel generally perform by transesterification of vegetable oils with low molecular weight alcohol, mainly methanol, using chemical catalysts. Methanol is petrochemical product that makes biodiesel producing from methanol to be not pure renewable energy source. Therefore, ethanol as a product produced by fermentation processes. It appears as a potential feed stock that makes biodiesel to be pure renewable alternative fuel. The research is conducted based on two biodiesel production processes by reacting soybean oils with methanol and ethanol. Life cycle assessment was carried out in order to evaluate the environmental impacts and to identify the process alternative. Nine mid-point impact categories are investigated. The results indicate that better performance on Abiotic Depletion Potential (ADP) and Acidification Potential (AP) are observed in biodiesel production from methanol when compared with biodiesel production from ethanol due to less energy consumption during the production processes. Except for ADP and AP, using methanol as feed stock does not show any advantages over biodiesel from ethanol. The single score method is also included in this study in order to identify the best option between two processes of biodiesel production. The global normalization and weighting factor based on eco-taxes are used and it shows that producing biodiesel form ethanol has less environmental load compare to biodiesel from methanol.

Keywords: biodiesel, ethanol, life cycle assessment, methanol, soybean oil

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Authors: Jingjing Huang, Nengwei Li, Guanghua Wei, Jiabin You, Chao Wang, Junliang Zhang

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In this work, molecular dynamics (MD) simulation is applied to analyze the mass transport process in the cathode of proton exchange membrane fuel cell (PEMFC), of which all types of molecules situated in the cathode is considered. a reasonable and effective MD simulation process is provided, and models were built and compared using both Materials Studio and LAMMPS. The mass transport is one of the key issues in the study of proton exchange membrane fuel cells (PEMFCs). In this report, molecular dynamics (MD) simulation is applied to analyze the influence of Nafion ionomer distribution and Pt nano-particle size on mass transport process in the cathode. It is indicated by the diffusion coefficients calculation that a larger quantity of Nafion, as well as a higher equivalent weight (EW) value, will hinder the transport of oxygen. In addition, medium-sized Pt nano-particles (1.5~2nm) are more advantageous in terms of proton transport compared with other particle sizes (0.94~2.55nm) when the center-to-center distance between two Pt nano-particles is around 5 nm. Then mass transport channels are found to be formed between the hydrophobic backbone and the hydrophilic side chains of Nafion ionomer according to the radial distribution function (RDF) curves. And the morphology of these channels affected by the Pt size is believed to influence the transport of hydronium ions and, consequently the performance of PEMFC.

Keywords: cathode catalytic layer, mass transport, molecular dynamics, proton exchange membrane fuel cell

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Authors: Yalcin Kaya, Fatma Arslan, Ahmet Selim Kaya

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This study aimed to determine the undesirable hypertrophic anomalies in the body of females and to investigate how they can be affected by the exercise program according to the applied 8 week individual conditions. The research was carried out on 35 women who did not have any regular previous sports practice and had an approximate age of 30 ± 5.0 at the gymnasium because of their asymmetric structure and weight gain of the body. Measurements of width, depth, and periphery were taken from the participants' body, and the exercise protocol was applied for 8 weeks according to the individual measurements in accordance with the obtained measurements. After 8 weeks, the same measurements were applied again. Measurements were made by using ruler and paper tape. The findings were evaluated and differences were analyzed by paired sample t test. According to the findings obtained, ulnae distal proiecturas width averages were 44.77 ± 3.65 and 43.52 ± 3.47 pre- and post-exercise respectively. Bithorachanteric width averages were 29.3 ± 3.12 before exercise and 26.67 ± 3.27 after exercise. Average abdominal widths were observed as 18.64 ± 4.14 (before exercise) and 18.01 ± 6.27 (after exercise). The distances between the malleolus were measured as 16.98 ± 1.62 (before exercise) and 16.70 ± 1.64 (after exercise). The results were statistically significant (p < 0.05). The mean of pre-exercise Externus abdominis circumference was 93.97 ± 8.91, and the mean of post-exercise mean was 90.82 ± 8.24. The results are statistically significant (p < 0.05). In conclusion, findings of the study show that inactivity, daily uncontrolled activities or erroneous postural postures, malnutrition cause some anomalies in the human body. However, with consciously standardized and regular exercises, these abnormalities are reduced by an eight-week exercise protocol in parallel with the expulsion of excess kilos and can be removed when working much longer and fitter, it is proposed to be healthier and more beautiful in appearance.

Keywords: women, body, circumference-width and depth measurements, hypertrophy, exercise

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Authors: Shahryar Aftabi, Saeed Fathi, Mohammad H. Aminfar

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It is well known that cemented sand is one of the best approaches for soil stabilization. In some cases, a blend of sand, cement and other pozzolan materials such as zeolite, nano-particles and fiber can be widely (commercially) available and be effectively used in soil stabilization, especially in road construction. In this research, we investigate the effects of CaO which is based on the geotechnical characteristics of zeolite composition with sandy silt soil. Zeolites have low amount of CaO in their structures, that is, varying from 3% to 10%, and by removing the cement paste, we want to investigate the effect of zeolite pozzolan without any activator on soil samples strength. In this research, experiments are concentrated on various weight percentages of zeolite in the soil to examine the effect of the zeolite on drainage shear strength and California Bearing Ratio (CBR) both with and without curing. The study also investigates their liquid limit and plastic limit behavior and makes a comparative result by using Feng's and Wroth-Wood's methods in fall cone (cone penetrometer) device; in the final the SEM images have been presented. The results show that by increasing the percentage of zeolite in without-curing samples, the fine zeolite particles increase some soil's strength, but in the curing-state we can see a relatively higher strength toward without-curing state, since the zeolites have no plastic behavior, the pozzolanic property of zeolites plays a much higher role than cementing properties. Indeed, it is better to combine zeolite particle with activator material such as cement or lime to gain better results.

Keywords: California bearing ratio, CBR, direct shear, fall-cone, sandy silt, SEM, zeolite

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Authors: Nataly De La Pava, Christian S. A. Silva-Torres, Arodí P. Favaris, José Maurício S. Bento

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The lady beetles Tenuisvalve notata and Cryptolaemus montrouzieri are important predators of mealybugs (Hemiptera: Pseudococcidae). Similar to the prey, these lady beetles produce wax filaments that cover their body during the larval stage. It has been hypothesized that lady beetle body wax chemical profiles are similar to their prey as i) a mechanism of camouflage and ii) conveying protection to the lady beetle larvae against aphid-tending predatory ants. In this study, we tested those hypotheses for the predators T. notata and C. montrouzieri and two mealybug prey species, Ferissia dasyrilii, and Planococcus citri. Next, we evaluated the influence of feeding on cuticular chemistry during predator development and identified possible metabolic costs associated with wax production. Cuticular wax samples were analyzed by GC-MS and GC-FID. Also, the metabolic cost linked to wax production was evaluated in the 4th instar larvae of the two predators when subjected to body wax removal from 0 to 4 times. Results showed that predator body wax profiles are not similar to the chemical profile of prey body wax. There was a metabolic cost associated with wax removal; predators (male and female) showed a significant reduction in adult body weight when the wax was removed. This suggests the reallocation of energy to wax replacement instead of growth. In addition, it was detected effects of wax removal on fecundity and egg viability. The results do not support the hypothesis that predators mimic the cuticular wax composition of prey as a means of camouflage.

Keywords: biological control, body wax, coccinellids, cuticular hydrocarbons, metabolism cost, reproduction

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Authors: Salah Hadjout, Mohamed Zouidi

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In Algeria, several works carried out in recent years have shown the importance of fusarium head blight in durum wheat. Indeed, this disease is caused by a complex of Fusarium genus pathogens. The research carried out reports that F. culmorum is the main species infecting cereals. These informations motivated our interest in the field evaluation of the behavior of some durum wheat genotypes (parental varieties and lines) with regard to fusarium head blight, mainly caused by four F. culmorum isolates. Our research work focused on following the evolution of symptom development throughout the grain filling, after artificial inoculation of ears by Fusarium isolates in order to establish a first image on the differences in genotype behavior to fusarium haed blight. Field disease assessment criteria are: disease assessment using a grading scale, thousand grain weight measurement and AUDPC. The results obtained revealed that the varieties and lines resulting from crosses had a quite different level of sensitivity to F. culmorum species and no genotype showed complete resistance in our culture conditions. Among the material tested, some lines showed higher resistance than their parents. The results also show a slight behavioral variability also linked to the aggressiveness of the Fusarium species studied in this work. Our results open very important research perspectives on fusarium head blight, in particular the search for toxins produced by Fusarium species.

Keywords: fusarium head blight, durum wheat, Fusarium culmorum, field disease assessment criteria, Algeria

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Authors: Abderrahim El Maslouhi

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The paper aims to analyze an often-overlooked dimension of global constitutionalism, which is the rise of the regulatory state and its impact on parliamentary dynamics in transition regimes. In contrast to Majone’s technocratic vision of convergence towards a single regulatory system based on competence and efficiency, national transpositions of regulatory governance and, in general, the relationship to global standards primarily depend upon a number of distinctive parameters. These include policy formation process, speed of change, depth of parliamentary tradition and greater or lesser vulnerability to the normative conditionality of donors, interstate groupings and transnational regulatory bodies. Based on a comparison between three post-Arab Spring countries -Morocco, Tunisia, and Egypt, whose constitutions have undergone substantive review in the period 2011-2014- and some European Union state members, the paper intends, first, to assess the degree of permeability to global constitutionalism in different contexts. A noteworthy divide emerges from this comparison. Whereas European constitutions still seem impervious to the lexicon of global constitutionalism, the influence of the latter is obvious in the recently drafted constitutions in Morocco, Tunisia, and Egypt. This is evidenced by their reference to notions such as ‘governance’, ‘regulators’, ‘accountability’, ‘transparency’, ‘civil society’, and ‘participatory democracy’. Second, the study will provide a contextual account of internal and external rationales underlying the constitutionalization of regulatory governance in the cases examined. Unlike European constitutionalism, where parliamentarism and the tradition of representative government function as a structural mechanism that moderates the de-parliamentarization effect induced by global constitutionalism, Arab constitutional transitions have led to a paradoxical situation; contrary to the public demands for further parliamentarization, the 2011 constitution-makers have opted for a de-parliamentarization pattern. This is particularly reflected in the procedures established by constitutions and regular legislation, to handle the interaction between lawmakers and regulatory bodies. Once the ‘constitutional’ and ‘independent’ nature of these agencies is formally endorsed, the birth of these ‘fourth power’ entities, which are neither elected nor directly responsible to elected officials, will raise the question of their accountability. Third, the paper shows that, even in the three selected countries, the de-parliamentarization intensity is significantly variable. By contrast to the radical stance of the Moroccan and Egyptian constituents who have shown greater concern to shield regulatory bodies from legislatures’ scrutiny, the Tunisian case indicates a certain tendency to provide lawmakers with some essential control instruments (e. g. exclusive appointment power, adversarial discussion of regulators’ annual reports, dismissal power, later held unconstitutional). In sum, the comparison reveals that the transposition of the regulatory state model and, more generally, sensitivity to the legal implications of global conditionality essentially relies on the evolution of real-world power relations at both national and international levels.

Keywords: Arab legislatures, de-parliamentarization, global constitutionalism, normative conditionality, regulatory state

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Authors: Nadine Abuqtaish

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Females’ participation in athletic sports events has increased in the last decades, and the discovery of eating disorders and menstrual dysfunction has been evident since the early 1980s. The term “Female athlete triad” was initially defined by the Task Force on Women’s Issues of the American College of Sports Medicine (ACSM) in 1992. Menstrual irregularities have been prevalent in competitive female athletes, especially in their adolescence and early adulthood age. Nutritional restrictions to maintain a certain physique and lean look are sought to be advantageous in female athletes such as gymnastics, cheerleading, or weight-sensitive sports such as endurance sports (cycling and marathoners). This stress places the female at risk of irregularities in their menstrual cycle which can lead them to lose their circadian estrogen levels. Estrogen is an important female reproductive hormone that plays a role in maintaining bone mass. Bone mineral density peaks by the age 25. Inadequate estrogen due to missed menstrual cycle or amenorrhea has been estimated to cause a yearly loss of 2% of bone mass, increasing the risk of osteoporosis in the postmenopausal phase. This paper is intended to have a better depth understanding of whether female athletes are being monitored by their official entities or coaches. A qualitative research method through online search engines and keywords “females, athletes, triad, amenorrhea, anorexia, osteoporosis” were used to collect the available primary sources from official public library databases. The latest consensus was published in 2014 by the Female Athlete Triad Coalition and the need for further research and emphasis on this issue is still lacking.

Keywords: female, athlete, triad, amenorrhea, anorexia, bone loss

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Authors: Ayman Othman, Tallat Ali

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The successive increase of generated waste materials like glass has led to many environmental problems. Using crushed waste glass in hot mix asphalt paving has been though as an alternative to landfill disposal and recycling. This paper discusses the possibility of utilizing crushed waste glass, as a part of fine aggregate in hot mix asphalt in Egypt. This is done through evaluation of the mechanical properties of asphalt concrete mixtures mixed with waste glass and determining the appropriate glass content that can be adapted in asphalt pavement. Four asphalt concrete mixtures with various glass contents, namely; 0%, 4%, 8% and 12% by weight of total mixture were studied. Evaluation of the mechanical properties includes performing Marshall stability, indirect tensile strength, fracture energy and unconfined compressive strength tests. Laboratory testing had revealed the enhancement in both compressive strength and Marshall stability test parameters when the crushed glass was added to asphalt concrete mixtures. This enhancement was accompanied with a very slight reduction in both indirect tensile strength and fracture energy when glass content up to 8% was used. Adding more than 8% of glass causes a sharp reduction in both indirect tensile strength and fracture energy. Testing results had also shown a reduction in the optimum asphalt content when the waste glass was used. Measurements of the heat loss rate of asphalt concrete mixtures mixed with glass revealed their ability to hold heat longer than conventional mixtures. This can have useful application in asphalt paving during cold whether or when a long period of post-mix transportation is needed.

Keywords: waste glass, hot mix asphalt, mechanical performance, indirect tensile strength, fracture energy, compressive strength

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Authors: Lorcelie B. Taclan, Jolly S. Balila, Maribel Balagtas, Eunice M. Aclan, Myrtle C. Orbon, Emson Y. Taclan, Irenea A. Centeno

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Okara (soy pulp), a by-product and waste from the production of soymilk, tufo and tokwa and soybean-based vegan food products is readily available in the university thrice a week. The Food Factory owned and managed by AUP produces these food products weekly. Generally the study was conducted to determine the drying kinetics of soya pulp using the MCHPD. Specifically, it aimed to establish the time of drying; moisture loss per hour and percent moisture content of soya pulp and to establish the dried okara as an ingredient to other foods. The MCHPD is drying equipment that has an ideal drying condition of 50.00C and 10.0% relative humidity. Fresh and wet soya pulp were weighed at 1.0 kg per tray (21 drying trays), laid on the trays lined with cheese cloth. The MCHPD was set to desired drying conditions. Weight loss was monitored every hour and calculated using standard formulas. Research results indicated that the drying time for soya pulp was 19.0 hours; the % moisture content was reduced from 87.6.0% to 9.7.0% at an average moisture loss of 3.0 g/hr. The nutritional values of okara were favorably maintained with enhanced color. The dried okara was added as an ingredient to other healthy bakery products produced by the AUP Food Factory. Making use of okara would add nutritional values to other food products and would also help waste management concerns inside the university.

Keywords: okara, MCHPD, drying kinetics, nutritional values, waste management

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Authors: Mohammad Naeem Lakanwall

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Background:The thyroid gland, located just below the vocal cord on each side of and anterior to the trachea, is one of the main endocrine glands. Its normal weight is 15 to 20 grams in adults. The thyroid secretes two most important hormones, thyroxine and triiodothyronine, usually called T4 and T3, respectively. These hormones greatly increase the metabolic rate of the body. In addition to T3 and T4, the thyroid gland secrets calcitonin as well which is a significant hormone for calcium metabolism. Objective: The aim of this study is to estimate the proportion of and to identify factors associated with thyroid dysfunction among individuals coming to a tertiary care facility in Kabul, Afghanistan. Material and Methods: An analytical cross-sectional study design was conducted from July to Sep 2018. Blood samples were obtained, serum TSH levels were measured, and the patients were divided into three diagnostic categories according to their serum TSH concentrations. 1) Hypothyroidism 2) Hyperthyroidism 3) Normal thyroid Results: A total of 127 individuals were part of the sample for the final analysis. The majority of study participants (77%) were females. A large number of the participants (92%) did not have a family history of thyroid dysfunction and the majority of the female participants, (85%) were not pregnant in the last two years. Furthermore, 98% of participants, were non-smokers. Conclusion: The findings of the current study showed a high prevalence of thyroid dysfunctions in individuals coming to FMIC for thyroid functions tests. The findings also indicated that aging and smoking are the factors associated with thyroid dysfunctions. Further studies are needed to find out the prevalence of and factors associated with thyroid dysfunctions.

Keywords: Afghanistan, Kabul, hypothyroidism, hyperthyroidism, triiodothyronine, thyroxine

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Authors: Setya Winarno

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Due to abundant Merapi volcanic sand in Yogyakarta City, many local people have utilized it for mass production of concrete blocks through mini plants although their products are low in quality. This paper presents a practice model for quality improvement in this situation in order to supply the current customer interest in good quality of construction material. The method of this research was to investigate a techno economic evaluation through laboratory test and interview. Samples of twenty existing concrete blocks made by local people had only 19.4 kg/cm2 in average compression strength which was lower than the minimum Indonesian standard of 25 kg/cm2. Through repeat testing in laboratory for fulfilling the standard, the concrete mix design of water cement ratio should not be more than 0.64 by weight basis. The proportion of sand as aggregate content should not be more than 9 parts to 1 part by volume of Portland cement. Considering the production cost, the basic price was Rp 1,820 for each concrete block, comparing to Rp 2,000 as a normal competitive market price. At last, the model describes (a) maximum water cement ratio is 0.64, (b) maximum proportion of sand and cement is 1:9, (c) the basic price is about Rp. 1,820.00 and (d) strategies to win the competitive market on mass production of concrete blocks are focus in quality, building relationships with consumer, rapid respond to customer need, continuous innovation by product diversification, promotion in social media, and strict financial management.

Keywords: concrete block, good quality, improvement model, diversification

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Authors: Sharmili Routray, Kishor Chandra Biswal

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The use of corrosion resistant fiber reinforced polymer (FRP) reinforcement is beneficial in structures particularly those exposed to deicing salts, and/or located in highly corrosive environment. Generally Glass, Carbon and Aramid fibers are used for the strengthening purpose of the structures. Due to the necessities of low weight and high strength materials, it is required to find out the suitable substitute with low cost. Recent developments in fiber production technology allow the strengthening of structures using Basalt fiber which is made from basalt rock. Basalt fiber has good range of thermal performance, high tensile strength, resistance to acids, good electro‐magnetic properties, inert nature, resistance to corrosion, radiation and UV light, vibration and impact loading. This investigation focuses on the effect of fibre content and fiber orientation of basalt fibre on mechanical properties of the fabricated composites. Specimen prepared with unidirectional Basalt fabric as reinforcing materials and epoxy resin as a matrix in polymer composite. In this investigation different fiber orientation are taken and the fabrication is done by hand lay-up process. The variation of the properties with the increasing number of plies of fiber in the composites is also studied. Specimens are subjected to tensile strength test and the failure of the composite is examined with the help of INSTRON universal testing Machine (SATEC) of 600 kN capacities. The average tensile strength and modulus of elasticity of BFRP plates are determined from the test Program.

Keywords: BFRP, fabrication, Fiber Reinforced Polymer (FRP), strengthening

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Authors: Mohammadreza Aghasadeghi, Mojtaba Hamidi-Fard, Seyed Amir Sadeghi, Ashkan Noorbakhsh

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Introduction: HIV is known as one of the most important pathogens and mortality in all human societies, but unfortunately, no definitive cure has been found for it. Due to its weakened immune system, this virus causes a variety of primary and secondary opportunistic infections. Cytomegalovirus (CMV) is one of the most relevant opportunistic viruses seen in HIV-positive people that cause various infections in HIV-positive people. This virus causes various infections in HIV-positive people, such as retinal infection (CMVR), gastrointestinal infections, diarrhea, severe weight loss, and cerebrospinal fluid problems. These various infections make it important to evaluate the prevalence of CMV in HIV-positive people to diagnose it quickly and in a timely manner. This infection in HIV-positive people reduces life expectancy and causes serious harm to patients. However, a simple test in HIV-positive people can prevent the virus from progressing. Material and Methods: In this study, we collected 200 blood samples (including 147 men and 53 women) from HIV-positive individuals and examined the frequency of CMV-DNA in these cases by real-time PCR method. In the next step, the data was analyzed by SPSS software, and then we obtained the relationship between age, sex, and the frequency of CMV in HIV-positive individuals. Results: The total frequency of CMV DNA was about 59%, which is a relatively high prevalence due to the age range of the subjects. The frequency in men was 61.2% and 52.8% in women. This frequency was also higher in males than females. We also observed more frequency in two age groups of 16 to 30 years and 31 to 45 years. Discussion: Due to the high prevalence of CMV in HIV-positive individuals and causing serious problems in this group of people, this study was shown that both the patients and the community should pay more attention to this issue. Ministry of Health, as a stakeholder organization, can make CMV DNA testing mandatory as soon as a person is HIV positive.

Keywords: CMV, HIV, AIDS, real-time PCR, SPSS

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Authors: Abdul G. Miah, Hirotada Tsujii, Ummay Salma, Iwao Takeda

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The study was designed to investigate the effects of dietary Selenium-enriched radish sprouts (Se-RS), Vitamin E (Vit E) and Rhodobacter capsulatus (RC) on broiler's immunity, cholesterol concentration and fatty acid composition in broiler meat. A total of 100 two-week-old male broiler chicks were randomly assigned into 5 dietary groups, such as i) Control; ii) Se-RS (5 μg/kg Se-RS); iii) Se-RS+RC (5 μg/kg Se-RS + 0.2 g/kg RC); iv) Se-RS+Vit E (5 μg/kg Se-RS + 50 mg/kg Vit E) and v) Se-RS+RC+Vit E (5 μg/kg Se-RS + 0.2 g/kg RC + 50 mg/kg Vit E). The broilers were offered ad libitum specific diets and clean drinking water. After the end of 3-wk of feeding period, serum cholesterol and triglycerides concentrations were decreased (p<0.05) specially, in the broilers fed Se-RS+RC+Vit E supplemented diet compared to the broilers fed control diet. At the end of the 6-wk feeding period, Se-RS+RC+Vit E supplemented diet significantly (p<0.05) reduced cholesterol and triglycerides concentrations, and improved the ratio of unsaturated fatty acids (UFA) to saturated fatty acids (SFA) in broiler meat. The highest (p<0.05) number of leukocytes was observed in the broilers fed Se-RS+RC+Vit E supplemented diet than that of the broilers fed control diet. Spleen, bursa and thymus weight were significantly (p<0.05) increased by Se-RS+RC+Vit E supplemented diet than the control diet. Compared to the control diet, Se-RS+RC+Vit E supplemented diet significantly (p<0.05) increased foot web index. Moreover, there was no mortality in all groups of broilers during the experimental period. Therefore, the study may conclude that there are dual benefits of Se-RS+RC+Vit E supplementation in broiler diet improved immunity and meat quality for health conscious consumers.

Keywords: hypocholesterolemia, immunity of broiler, rhodobacter capsulatus, selenium-enriched radish sprouts, vitamin E

Procedia PDF Downloads 293

Authors: Vittorio Astarita, Giuseppe Guido, Vincenzo Pasquale Giofre, Alessandro Vitale

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Traffic microsimulation has been used extensively to evaluate consequences of different traffic planning and control policies in terms of travel time delays, queues, pollutant emissions, and every other common measured performance while at the same time traffic safety has not been considered in common traffic microsimulation packages as a measure of performance for different traffic scenarios. Vehicle conflict techniques that were introduced at intersections in the early traffic researches carried out at the General Motor laboratory in the USA and in the Swedish traffic conflict manual have been applied to vehicles trajectories simulated in microscopic traffic simulators. The concept is that microsimulation can be used as a base for calculating the number of conflicts that will define the safety level of a traffic scenario. This allows engineers to identify unsafe road traffic maneuvers and helps in finding the right countermeasures that can improve safety. Unfortunately, most commonly used indicators do not consider conflicts between single vehicles and roadside obstacles and barriers. A great number of vehicle crashes take place with roadside objects or obstacles. Only some recent proposed indicators have been trying to address this issue. This paper introduces a new procedure based on the simulation of potential crash events for the evaluation of safety levels in microsimulation traffic scenarios, which takes into account also potential crashes with roadside objects and barriers. The procedure can be used to define new conflict indicators. The proposed simulation procedure generates with the random perturbation of vehicle trajectories a set of potential crashes which can be evaluated accurately in terms of DeltaV, the energy of the impact, and/or expected number of injuries or casualties. The procedure can also be applied to real trajectories giving birth to new surrogate safety performance indicators, which can be considered as “simulation-based”. The methodology and a specific safety performance indicator are described and applied to a simulated test traffic scenario. Results indicate that the procedure is able to evaluate safety levels both at the intersection level and in the presence of roadside obstacles. The procedure produces results that are expressed in the same unity of measure for both vehicle to vehicle and vehicle to roadside object conflicts. The total energy for a square meter of all generated crash can be used and is shown on the map, for the test network, after the application of a threshold to evidence the most dangerous points. Without any detailed calibration of the microsimulation model and without any calibration of the parameters of the procedure (standard values have been used), it is possible to identify dangerous points. A preliminary sensitivity analysis has shown that results are not dependent on the different energy thresholds and different parameters of the procedure. This paper introduces a specific new procedure and the implementation in the form of a software package that is able to assess road safety, also considering potential conflicts with roadside objects. Some of the principles that are at the base of this specific model are discussed. The procedure can be applied on common microsimulation packages once vehicle trajectories and the positions of roadside barriers and obstacles are known. The procedure has many calibration parameters and research efforts will have to be devoted to make confrontations with real crash data in order to obtain the best parameters that have the potential of giving an accurate evaluation of the risk of any traffic scenario.

Keywords: road safety, traffic, traffic safety, traffic simulation

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Authors: Jake Tempo, Taylor Smithurst, Jen Leah, Skye Waddingham, Amanda Catlin, Richard Cetti

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Introduction: Percutaneous nephrolithotomy (PCNL) is the gold-standard procedure for removing large or complex renal stones. Many operating positions can be used, and the debate over the ideal position continues. PCNL can be a long procedure during which patients can sustain pressure injuries. These injuries are often underreported in the literature. Interface pressure mapping records the pressure loading between a surface and the patient. High pressures with prolonged loading result in ischaemia, muscle deformation, and reperfusion which can cause skin breakdown and muscular injury. We compared the peak pressure indexes of common PCNL positions to identify positions which may be at high risk of pressure injuries. We hope the data can be used to adapt high-risk positions so that the PPI can be lessened by either adapting the positions or by using adjuncts to lower PPI. Materials and Methods: We placed a 23-year-old male subject in fourteen different PCNL positions while performing interface pressure mapping. The subject was 179 cm with a weight of 63.3 kg, BMI 19.8kg/m². Results: Supine positions had a higher mean PPI (119mmHg (41-137)) compared to prone positions (64mmHg (32-89)) (p=0.046 two tailed t-test). The supine flexed position with a bolster under the flank produced the highest PPI (194mmHg), and this was at the sacrum. Peak pressure indexes >100mmHg were recorded in eight PCNL positions. Conclusion: Supine PCNL positions produce higher PPI than prone PCNL positions. Our study shows where ‘at risk’ bony prominences are for each PCNL position. Surgeons must ensure these areas are protected during prolonged operations.

Keywords: PCNL, pressure ulcer, interface pressure mapping, surgery

Procedia PDF Downloads 79

Authors: Yinglisong, Jingge Chen, Jingxuan Chen, Yan Wang, Hui Huang, Jing Zhnag, Qianqian Zhang, Zhenzhen Zhang, Ji Zhang

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Purpose: The study aims to establish a nomogram prediction model for postpartum hemorrhage (PPH) in vaginal delivery. Patients and Methods: Clinical data were retrospectively collected from vaginal delivery patients admitted to a hospital in Zhengzhou, China, from June 1, 2022 - October 31, 2022. Univariate and multivariate logistic regression were used to filter out independent risk factors. A nomogram model was established for PPH in vaginal delivery based on the risk factors coefficient. Bootstrapping was used for internal validation. To assess discrimination and calibration, receiver operator characteristics (ROC) and calibration curves were generated in the derivation and validation groups. Results: A total of 1340 cases of vaginal delivery were enrolled, with 81 (6.04%) having PPH. Logistic regression indicated that history of uterine surgery, induction of labor, duration of first labor, neonatal weight, WBC value (during the first stage of labor), and cervical lacerations were all independent risk factors of hemorrhage (P <0.05). The area-under-curve (AUC) of ROC curves of the derivation group and the validation group were 0.817 and 0.821, respectively, indicating good discrimination. Two calibration curves showed that nomogram prediction and practical results were highly consistent (P = 0.105, P = 0.113). Conclusion: The developed individualized risk prediction nomogram model can assist midwives in recognizing and diagnosing high-risk groups of PPH and initiating early warning to reduce PPH incidence.

Keywords: vaginal delivery, postpartum hemorrhage, risk factor, nomogram

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