Search results for: cohort analysis

Authors: Ritika Chaturvedi

Abstract:

Introduction: Sexual objectification, characterized by the reduction of an individual to a mere object of sexual desire, remains a pervasive societal issue with profound repercussions on individual well-being. Such experiences, often rooted in systemic and cultural norms, have long-lasting implications for mental and emotional health. This study aims to explore the intricate relationship between experiences of sexual objectification and insidious trauma, further investigating the potential moderating effects of overexcitability as proposed by Dabrowski's theory of positive disintegration. Methodology: The research involved a comprehensive cohort of 204 women, spanning ages from 18 to 65 years. Participants were tasked with completing self-administered questionnaires designed to capture their experiences with sexual objectification. Additionally, the questionnaire assessed symptoms indicative of insidious trauma and explored overexcitability across five distinct domains: emotional, intellectual, psychomotor, sensory, and imaginational. Employing advanced statistical techniques, including multiple regression and moderation analysis, the study sought to decipher the intricate interplay among these variables. Findings: The study's results revealed a compelling positive correlation between experiences of sexual objectification and the onset of symptoms indicative of insidious trauma. This correlation underscores the profound and detrimental effects of sexual objectification on an individual's psychological well-being. Interestingly, the moderation analyses introduced a nuanced understanding, highlighting the differential roles of various overexcitability. Specifically, emotional, intellectual, and sensual overexcitability were found to exacerbate trauma symptomatology. In contrast, psychomotor overexcitability emerged as a protective factor, demonstrating a mitigating influence on the relationship between sexual objectification and trauma. Implications: The study's findings hold significant implications for a diverse array of stakeholders, encompassing mental health practitioners, educators, policymakers, and advocacy groups. The identified moderating effects of overexcitability emphasize the need for tailored interventions that consider individual differences in coping and resilience mechanisms. By recognizing the pivotal role of overexcitability in modulating the traumatic consequences of sexual objectification, this research advocates for the development of more nuanced and targeted support frameworks. Moreover, the study underscores the importance of continued research endeavors to unravel the intricate mechanisms and dynamics underpinning these relationships. Such endeavors are crucial for fostering the evolution of informed, evidence-based interventions and strategies aimed at mitigating the adverse effects of sexual objectification and promoting holistic well-being.

Keywords: sexual objectification, insidious trauma, emotional overexcitability, intellectual overexcitability, sensual overexcitability, psychomotor overexcitability, imaginational overexcitability

Procedia PDF Downloads 33

Authors: Lohendy Munoz-Vargas, Stephen O. Opiyo, Rose Digianantonio, Michele L. Williams, Asela Wijeratne, Gregory Habing

Abstract:

Non-typhoidal Salmonella enterica is a zoonotic pathogen with critical importance in animal and public health. The persistence of Salmonella on farms affects animal productivity and health, and represents a risk for food safety. The intestinal microbiota plays a fundamental role in the colonization and invasion of this ubiquitous microorganism. To overcome the colonization resistance imparted by the gut microbiome, Salmonella uses invasion strategies and the host inflammatory response to survive, proliferate, and establish infections with diverse clinical manifestations. Cattle serve as reservoirs of Salmonella, and periparturient cows have high prevalence of Salmonella shedding; however, to author`s best knowledge, little is known about the association between the gut microbiome and the onset of Salmonella shedding during the periparturient period. Thus, the objective of this study was to assess the association between changes in bacterial communities and the onset of Salmonella shedding in cattle approaching parturition. In a prospective cohort study, fecal samples from 98 dairy cows originating from four different farms were collected at four time points relative to calving (-3 wks, -1 wk, +1 wk, +3 wks). All 392 samples were cultured for Salmonella. Sequencing of the V4 region of the 16S rRNA gene using the Illumina platform was completed to evaluate the fecal microbiome in a selected sample subset. Analyses of microbial composition, diversity, and structure were performed according to time points, farm, and Salmonella onset status. Individual cow fecal microbiomes, predominated by Bacteroidetes, Firmicutes, Spirochaetes, and Proteobacteria phyla, significantly changed before and after parturition. Microbial communities from different farms were distinguishable based on multivariate analysis. Although there were significant differences in some bacterial taxa between Salmonella positive and negative samples, our results did not identify differences in the fecal microbial diversity or structure for cows with and without the onset of Salmonella shedding. These data suggest that determinants other than the significant changes in the fecal microbiome influence the periparturient onset of Salmonella shedding in dairy cattle.

Keywords: dairy cattle, microbiome, periparturient, Salmonella

Procedia PDF Downloads 149

Authors: Dativa Maria Aliddeki, Fred Monje, Godfrey Nsereko, Benon Kwesiga, Daniel Kadobera, Alex Riolexus Ario

Abstract:

Background: Cholera is a severe gastrointestinal disease caused by Vibrio cholera. It has caused several pandemics. On 26 February 2018, a suspected cholera outbreak, with one death, occurred in School X in Hoima Municipality, western Uganda. We investigated to identify the scope and mode of transmission of the outbreak, and recommend evidence-based control measures. Methods: We defined a suspected case as onset of diarrhea, vomiting, or abdominal pain in a student or staff of School X or their family members during 14 February–10 March. A confirmed case was a suspected case with V. cholerae cultured from stool. We reviewed medical records at Hoima Hospital and searched for cases at School X. We conducted descriptive epidemiologic analysis and hypothesis-generating interviews of 15 case-patients. In a retrospective cohort study, we compared attack rates between exposed and unexposed persons. Results: We identified 15 cases among 75 students and staff of School X and their family members (attack rate=20%), with onset from 25-28 February. One patient died (case-fatality rate=6.6%). The epidemic curve indicated a point-source exposure. On 24 February, a student brought fried fish from her home in a fishing village, where a cholera outbreak was ongoing. Of the 21 persons who ate the fish, 57% developed cholera, compared with 5.6% of 54 persons who did not eat (RR=10; 95% CI=3.2-33). None of 4 persons who recooked the fish before eating, compared with 71% of 17 who did not recook it, developed cholera (RR=0.0, 95%CIFisher exact=0.0-0.95). Of 12 stool specimens cultured, 6 yielded V. cholerae. Conclusion: This cholera outbreak was caused by eating fried fish, which might have been contaminated with V. cholerae in a village with an ongoing outbreak. Lack of thorough cooking of the fish might have facilitated the outbreak. We recommended thoroughly cooking fish before consumption.

Keywords: cholera, disease outbreak, foodborne, global health security, Uganda

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Authors: Hendra Wibowo, Suprayitno Wardoyo, Dhama Shinta

Abstract:

Introduction: Pediatric pulmonary tuberculosis (TB) incidence was increasing, with many undetected cases. In complicated TB, treatment should consist of returning pulmonary function, preventing further complications, and eliminating bacteria. Complicated TB management was still controversial, and surgery was one of the treatments that should be evaluated in accordance with its role in the treatment of complicated TB. Method: This study was an evidence-based case report. The database used for the literature search were Cochrane, Medline, Proquest, and ScienceDirect. Keywords for the search were ‘primary pulmonary tuberculosis’, ‘surgery’, ‘lung resection’, and ‘children’. Inclusion criteria were studies in English or Indonesian, with children under 18 years old as subject, and full-text articles available. The assessment was done according to Oxford Centre for evidence-based medicine 2011. Results: Six cohort studies were analyzed. Surgery was indicated for patients with complicated TB that were unresponsive towards treatment. It should be noted that the experiments were done before the standard WHO antituberculosis therapy was applied; thus, the result may be different from the current application. Conclusion: Currently, there was no guideline on pulmonary resection. However, surgery yielded better mortality and morbidity in children with complicated pulmonary TB.

Keywords: pediatric, pulmonary, surgery, therapy, tuberculosis

Procedia PDF Downloads 91

Authors: Pallavi Roe

Abstract:

Violent crime is a significant public safety concern in urban areas across the United States, and Washington, DC, is no exception. This research discusses the prevalence and types of crime, particularly violent crime, in Washington, DC, along with the factors contributing to the high rate of violent crime in the city, including poverty, inequality, access to guns, and racial disparities. The organizations working towards ensuring safety in neighborhoods are also listed. The proposal to perform spatial and temporal analysis on violent crime and the use of guns in crime analysis is presented to identify patterns and trends to inform evidence-based interventions to reduce violent crime and improve public safety in Washington, DC. The stakeholders for crime analysis are also discussed, including law enforcement agencies, prosecutors, judges, policymakers, and the public. The anticipated result of the spatial and temporal analysis is to provide stakeholders with valuable information to make informed decisions about preventing and responding to violent crimes.

Keywords: crime analysis, spatial analysis, temporal analysis, violent crime

Procedia PDF Downloads 288

Authors: Dmitriy Syssoyev, Aslan Seitkamzin, Natalya Lim, Kamilla Mussina, Abduzhappar Gaipov, Dimitri Poddighe, Dinara Galiyeva

Abstract:

Background: Data on the epidemiology of congenital heart defects (CHD) in Kazakhstan is scarce. Therefore, the aim of this study was to describe the incidence, prevalence and all-cause mortality of patients with CHD in Kazakhstan, using national large-scale registry data from the Unified National Electronic Healthcare System (UNEHS) for the period of 2014-2020. Methods: In this retrospective cohort study, the included data pertained to all patients diagnosed with CHD in Kazakhstan and registered in UNEHS between January 2014 and December 2020. CHD was defined based on International Classification of Diseases 10th Revision (ICD-10) codes Q20-Q26. Incidence, prevalence, and all-cause mortality rates were calculated per 100,000 population. Survival analysis was performed using Cox proportional hazards regression modeling and the Kaplan-Meier method. Results: In total, 66,512 patients were identified. Among them, 59,534 (89.5%) were diagnosed with a single CHD, while 6,978 (10.5%) had more than two CHDs. The median age at diagnosis was 0.08 years (interquartile range (IQR) 0.01 – 0.66) for people with multiple CHD types and 0.39 years (IQR 0.04 – 8.38) for those with a single CHD type. The most common CHD types were atrial septal defect (ASD) and ventricular septal defect (VSD), accounting for 25.8% and 21.2% of single CHD cases, respectively. The most common multiple types of CHD were ASD with VSD (23.4%), ASD with patent ductus arteriosus (PDA) (19.5%), and VSD with PDA (17.7%). The incidence rate of CHD decreased from 64.6 to 47.1 cases per 100,000 population among men and from 68.7 to 42.4 among women. The prevalence rose from 66.1 to 334.1 cases per 100,000 population among men and from 70.8 to 328.7 among women. Mortality rates showed a slight increase from 3.5 to 4.7 deaths per 100,000 in men and from 2.9 to 3.7 in women. Median follow-up was 5.21 years (IQR 2.47 – 11.69). Male sex (HR 1.60, 95% CI 1.45 - 1.77), having multiple CHDs (HR 2.45, 95% CI 2.01 - 2.97), and living in a rural area (HR 1.32, 95% CI 1.19 - 1.47) were associated with a higher risk of all-cause mortality. Conclusion: The incidence of CHD in Kazakhstan has shown a moderate decrease between 2014 and 2020, while prevalence and mortality have increased. Male sex, multiple CHD types, and rural residence were significantly associated with a higher risk of all-cause mortality.

Keywords: congenital heart defects (CHD), epidemiology, incidence, Kazakhstan, mortality, prevalence

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Authors: Bela Siska Afrida, Wisnu Barlianto, Desy Wulandari, Ery Olivianto

Abstract:

Background: Allergic asthma, caused by IgE-mediated allergic reactions, remains a global health issue with high morbidity and mortality rates. Immunotherapy is the only etiology-based approach to treating asthma, but no standard biomarkers have been established to evaluate the therapy’s effectiveness. This study aims to determine the correlation between the ratios of serum levels of HDM-specific IgE/total IgE and Asthma Control Test (ACT) score as a biomarker of the response to immunotherapy in pediatric allergic asthma patients. Patient and Methods: This retrospective cohort study involved 26 pediatric allergic asthma patients who underwent HDM-specific subcutaneous immunotherapy for 14 weeks at the Pediatric Allergy Immunology Outpatient Clinic at Saiful Anwar General Hospital, Malang. Serum levels of HDM-Specific IgE and Total IgE were measured before and after immunotherapy using Chemiluminescence Immunoassay and Enzyme-linked Immunosorbent Assay (ELISA) method. Changes in asthma control were assessed using the ACT score. The Wilcoxon Signed Ranked Test and Spearman correlation test were used for data analysis. Results: There were 14 boys and 12 girls with a mean age of 6.48 ± 2.54 years. The study showed a significant decrease in serum HMD-specific levels before immunotherapy [9.88 ± 5.74 kuA/L] compared to those of 14 weeks after immunotherapy [4.51 ± 3.98 kuA/L], p = 0.000. Serum Total IgE levels significant decrease before immunotherapy [207.6 ± 120.8IU/ml] compared to those of 14 weeks after immunotherapy [109.83 ± 189.39 IU/mL], p = 0.000. The ratios of serum HDM-specific IgE/total IgE levels significant decrease before immunotherapy [0.063 ± 0.05] compared to those of 14 weeks after immunotherapy [0.041 ± 0.039], p = 0.012. There was also a significant increase in ACT scores before and after immunotherapy (each 15.5 ± 1.79 and 20.96 ± 2.049, p = 0.000). The correlation test showed a weak negative correlation between the ratios of HDM-specific IgE/total IgE levels and ACT score (p = 0.034 and r = -0.29). Conclusion: In conclusion, this study showed that a decrease in HDM-specific IgE levels, total IgE levels, and HDM-specific IgE/total IgE ratios, and an increase in ACT score, was observed after 14 weeks of HDM-specific subcutaneous immunotherapy. The weak negative correlation between the HDM-specific IgE/total IgE ratio and the ACT score suggests that this ratio can serve as a potential biomarker of the effectiveness of immunotherapy in treating pediatric allergic asthma patients.

Keywords: HDM-specific IgE/total IgE ratio, ACT score, immunotherapy, allergic asthma

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Authors: Jie Liu, Xudong Luo, Pingping Lin, Yifan Fan

Abstract:

Facebook, Twitter, Weibo, and other social media and significant e-commerce sites generate a massive amount of online texts, which can be used to analyse people’s opinions or sentiments for better decision-making. So, sentiment analysis, especially fine-grained sentiment analysis, is a very active research topic. In this paper, we survey various methods for fine-grained sentiment analysis, including traditional sentiment lexicon-based methods, machine learning-based methods, and deep learning-based methods in aspect/target/attribute-based sentiment analysis tasks. Besides, we discuss their advantages and problems worthy of careful studies in the future.

Keywords: sentiment analysis, fine-grained, machine learning, deep learning

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Authors: Sherry Ann Ganase, Sandra Sookram

Abstract:

In this paper, the vulnerability level to climate change is analysed using a comprehensive index, consisting of five pillars: human, social, natural, physical, and financial. A structural equation model is also applied to determine the indicators and relationships that exist between the observed environmental changes and the quality of life. Using survey data to model the results, a value of 0.382 is derived as the vulnerability level for San Pedro, where values closer to zero indicates lower vulnerability and values closer to one indicates higher vulnerability. The results showed the social pillar to be most vulnerable, with the indicator ‘participation’ ranked the highest in its cohort. Although, the environmental pillar is ranked as least vulnerable, the indicators ‘hazard’ and ‘biodiversity’ obtained scores closer to 0.4, suggesting that changes in the environment are occurring from natural and anthropogenic activities. These changes can negatively influence the quality of life as illustrated in the structural equation modelling. The study concludes by reporting on the need for collective action and participation by households in lowering vulnerability to ensure sustainable development and livelihood.

Keywords: climate change, participation, San Pedro, structural equation model, vulnerability index

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Authors: A. B. Robert, Adam Pramadia, Calvin Andika

Abstract:

The main purpose of this study is to explore consumer loyalty characteristic of mobile phone category in Indonesia. Second, this research attempts to identify consumer segment and to explore their profile in each segment as the basis of marketing strategy formulation. This study used some tools of multivariate analysis such as discriminant analysis and cluster analysis. Discriminate analysis used to discriminate consumer loyal and not loyal by using particular variables. Cluster analysis used to reveal various segment in mobile phone category. In addition to having better customer understanding in each segment, this study used descriptive analysis and cross tab analysis in each segment defined by cluster analysis. This study expected several findings. First, consumer can be divided into two large group of loyal versus not loyal by set of variables. Second, this study identifies customer segment in mobile phone category. Third, exploring customer profile in each segment that has been identified. This study answer a call for additional empirical research into different product categories. Therefore, a replication research is advisable. By knowing the customer loyalty characteristic, and deep analysis of their consumption behavior and profile for each segment, this study is very advisable for high impact marketing strategy development. This study contributes body of knowledge by adding empirical study of consumer loyalty, segmentation analysis in mobile phone category by multiple brand analysis.

Keywords: customer loyalty, segmentation, marketing strategy, discriminant analysis, cluster analysis, mobile phone

Procedia PDF Downloads 579

Authors: Ritika Chaturvedi

Abstract:

Introduction: Sexual objectification, characterized by the reduction of an individual to a mere object of sexual desire, remains a pervasive societal issue with profound repercussions on individual well-being. Such experiences, often rooted in systemic and cultural norms, have long-lasting implications for mental and emotional health. This study aims to explore the intricate relationship between experiences of sexual objectification and insidious trauma, further investigating the potential moderating effects of overexcitabilities as proposed by Dabrowski's theory of positive disintegration. Methodology: The research involved a comprehensive cohort of 204 women, spanning ages from 18 to 65 years. Participants were tasked with completing self-administered questionnaires designed to capture their experiences with sexual objectification. Additionally, the questionnaire assessed symptoms indicative of insidious trauma and explored overexcitabilities across five distinct domains: emotional, intellectual, psychomotor, sensory, and imaginational. Employing advanced statistical techniques, including multiple regression and moderation analysis, the study sought to decipher the intricate interplay among these variables. Findings: The study's results revealed a compelling positive correlation between experiences of sexual objectification and the onset of symptoms indicative of insidious trauma. This correlation underscores the profound and detrimental effects of sexual objectification on an individual's psychological well-being. Interestingly, the moderation analyses introduced a nuanced understanding, highlighting the differential roles of various overexcitabilities. Specifically, emotional, intellectual, and sensual overexcitabilities were found to exacerbate trauma symptomatology. In contrast, psychomotor overexcitability emerged as a protective factor, demonstrating a mitigating influence on the relationship between sexual objectification and trauma. Implications: The study's findings hold significant implications for a diverse array of stakeholders, encompassing mental health practitioners, educators, policymakers, and advocacy groups. The identified moderating effects of overexcitabilities emphasize the need for tailored interventions that consider individual differences in coping and resilience mechanisms. By recognizing the pivotal role of overexcitabilities in modulating the traumatic consequences of sexual objectification, this research advocates for the development of more nuanced and targeted support frameworks. Moreover, the study underscores the importance of continued research endeavors to unravel the intricate mechanisms and dynamics underpinning these relationships. Such endeavors are crucial for fostering the evolution of informed, evidence-based interventions and strategies aimed at mitigating the adverse effects of sexual objectification and promoting holistic well-being.

Keywords: sexual objectification, insidious trauma, emotional overexcitability, intellectual overexcitability, sensual overexcitability, psychomotor overexcitability, imaginational overexcitability

Procedia PDF Downloads 27

Authors: Jeonghun Lee

Abstract:

In this study, we investigated the relationship between stress and thyroid dysfunction in such patients who underwent thyroidectomy. This study included 101 patients who underwent thyroidectomy from January 2015 to June 2020 and experienced hypothyroidism. The included patients had good drug compliance with the same dosage of levothyroxine (LT4). The male-to-female ratio was 1:4.6, and the mean age was 45.4 years at surgery and 50.2 years at stressful events. Eighteen patients underwent lobectomies and, of these, 12 did not take LT4. The mean follow-up period was 49(8-93) months. Statistical analyses were performed using the paired t-test, Wilcoxon signed-rank test, and McNemer test using PROC MIXED with SAS 9.4. Forty-five patients (44.6%) had hypothyroidism with thyroid-stimulating hormone (TSH) >10 μIU/mL. There was distress in 81 patients and eustress in 10 patients. TSH levels increased during a mean 5.8 months (min 1, max 12) in 24 patients who specified the date of their life events. Even though each patient took the same dose of LT4, when the patients were under stress, both the free T4 and T3 decreased and TSH increased, regardless of whether the patient experienced distress or eustress (P <0.001). While adjusting for the effect of the free T4 and T3, TSH increased significantly in the patients after stress (P <0.001). For patients with thyroid cancer who are simultaneously experiencing life events, TSH may be used as a stress biomarker to enable the implementation of appropriate treatment and counseling strategies.

Keywords: endocrine, thyroid, thyroid function, biomarker, stress

Procedia PDF Downloads 62

Authors: Chothmal, Basant Agarwal

Abstract:

Sentiment analysis means to classify a given review document into positive or negative polar document. Sentiment analysis research has been increased tremendously in recent times due to its large number of applications in the industry and academia. Sentiment analysis models can be used to determine the opinion of the user towards any entity or product. E-commerce companies can use sentiment analysis model to improve their products on the basis of users’ opinion. In this paper, we propose a new One-class Support Vector Machine (One-class SVM) based sentiment analysis model for movie review documents. In the proposed approach, we initially extract features from one class of documents, and further test the given documents with the one-class SVM model if a given new test document lies in the model or it is an outlier. Experimental results show the effectiveness of the proposed sentiment analysis model.

Keywords: feature selection methods, machine learning, NB, one-class SVM, sentiment analysis, support vector machine

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Authors: Macie Matta, Ahmad Jabri, Stephanie Jackson

Abstract:

Introduction: In the absence of hypotension, pulmonary embolism (PE) causing right ventricular dysfunction or strain, whether confirmed by imaging or cardiac biomarkers, is deemed to be an intermediate-risk category. Urgent treatment of intermediate-risk PE can prevent progression to hemodynamic instability and death. Management options include thrombolysis, thrombectomy, or systemic anticoagulation. We aim to evaluate the short-term outcomes of a half-dose tissue plasminogen activator (tPA) for the management of intermediate-risk PE. Methods: We retrospectively identified adult patients diagnosed with intermediate-risk PE between the years 2000 and 2021. Demographic data, lab values, imaging, treatment choice, and outcomes were all obtained through chart review. Primary outcomes measured include major bleeding events and in-hospital mortality. Patients on standard systemic anticoagulation without receiving thrombolysis or thrombectomy served as controls. Patient data were analyzed using SAS®️ Software (version 9.4; Cary, NC) to compare individuals that received half-dose tPA with controls, and statistical significance was set at a p-value of 0.05. Results: We included 57 patients in our final analysis, with 19 receiving tPA. Patient characteristics and comorbidities were comparable between both groups. There was a significant difference between PE location, presence of acute deep vein thrombosis, and peak troponin level between both groups. The thrombolytic cohort was more likely to demonstrate a 60/60 sign and thrombus in transit finding on echocardiography than controls. The thrombolytic group was more likely to have major bleeding (17% vs 7.9%, p= 0.4) and in-hospital mortality (5.3% vs 0%, p=0.3); however, this was not statistically significant. Patients who received half-dose tPA had non-significantly higher rates of major bleeding and in-hospital mortality. Larger scale, randomized control trials are needed to establish the benefit and safety of thrombolytics in patients with intermediate-risk PE.

Keywords: pulmonary embolism, half dose thrombolysis, tissue plasminogen activator, cardiac biomarkers, echocardiographic findings, major bleeding event

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Authors: Hasan Fatih Ertuğrul, Beytullah Okur, Huseyin Üvet, Kadir Erkan

Abstract:

The objective of this paper is to analyze a 4-pole hybrid magnetic levitation system by using 3D finite element and analytical methods. The magnetostatic analysis of the system is carried out by using ANSYS MAXWELL-3D package. An analytical model is derived by magnetic equivalent circuit (MEC) method. The purpose of magnetostatic analysis is to determine the characteristics of attractive force and rotational torques by the change of air gap clearances, inclination angles and current excitations. The comparison between 3D finite element analysis and analytical results are presented at the rest of the paper.

Keywords: yoke hybrid electromagnet, 3D finite element analysis, magnetic levitation system, magnetostatic analysis

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Authors: Mardiana Madjid, Nurpudji Astuti Taslim, Suryani As'ad, Haerani Rasyid, Agussalim Bukhari

Abstract:

The high level of Urine Urea Nitrogen (UUN) indicates hypercatabolism occurs in hospitalized patients. High levels of Total Lymphocyte Count (TLC) indicates the immune system condition, adequate wound healing, and limit complication. Adequate dietary intake affects to decrease of hypercatabolism status in treated patient’s hospitals. Nitrogen Balance (NB) is simply the difference between nitrogen (N₂) intake and output. If more N₂ intake than output, then positive NB or anabolic will occur. This study aims to evaluate the effect of dietary intake in influencing balance nitrogen and total lymphocyte count. Method: A total of 43 patients admitted to a Wahidin Sudirohusodo Hospital between 2018 and 2019 for 10 days' treats are included. The inclusion criteria were patients who were treated for 10 days and receives food from the hospital orally. Patients did not experience gastrointestinal disorders such as vomiting and diarrhea and experience impair kidney function and liver function and expressed approval to participate in this study. During hospitalization, food intake, UUN, albumin serum, balance nitrogen, and TLC was assessed twice on day 1 and day 10. There is no Physician Clinical Nutritional intervention to correct food intake. UUN is 24 hours of urine collected on the second day after admission and the tenth day. Statistical analysis uses SPSS 24 with observational cohort methods. Result: The Forty-three participants completed the follow-up (27 men and 18 women). The age of fewer than 4 years is 22 people, 45 to 60 years is 16 people, and over 60 years is 4 people. The result of the study on day 1 obtained SGA score A, SGA score B, SGA score C are 8, 32, 3 until day 10 are 8, 31, 4, respectively. According to 24h dietary recalls, the energy intake during observation was from 522.5 ± 400.4 to 1011.9 ± 545.1 kcal/day P < 0.05, protein intake from 20.07 ± 17.2 to 40.3 ± 27.3 g/day P < 0.05, carbohydrates from 92.5 ± 71.6 to 184.8 ± 87.4 g/day, and fat from 5.5 ± 3.86 to 13.9 ± 13.9 g/day. The UUN during the observation was from 6.6 ± 7.3 to 5.5 ± 3.9 g/day, TLC decreased from 1622.9 ± 897.2 to 1319.9 ± 636.3/mm³ value target 1800/mm³, albumin serum from 3.07 ± 0.76 to 2.9 ± 0.57 g/day, and BN from -7.5 ± 7.2 to -3.1 ± 4.86. Conclusion: The high level of UUN needs to correct adequate dietary intake to improve NB and TLC status on hospitalized patients.

Keywords: adequate dietary intake, balance nitrogen, total lymphocyte count, urine urea nitrogen

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Authors: Vineet Agrawal, Deepanjali S., Medha R., Subitha L.

Abstract:

Background. Hospital malnutrition is a highly prevalent issue and is known to increase the morbidity, mortality, length of hospital stay, and cost of care. In India, studies on hospital malnutrition have been restricted to ICU, post-surgical, and cancer patients. We designed this study to assess the impact of hospital malnutrition on 30-day post-discharge and in-hospital mortality in patients admitted in the general medicine department, irrespective of diagnosis. Methodology. All patients aged above 18 years admitted in the medicine wards, excluding medico-legal cases, were enrolled in the study. Nutritional assessment was done within 72 h of admission, using Subjective Global Assessment (SGA), which classifies patients into three categories: Severely malnourished, Mildly/moderately malnourished, and Normal/well-nourished. Anthropometric measurements like Body Mass Index (BMI), Triceps skin-fold thickness (TSF), and Mid-upper arm circumference (MUAC) were also performed. Patients were followed-up during hospital stay and 30 days after discharge through telephonic interview, and their final diagnosis, comorbidities, and cause of death were noted. Multivariate logistic regression and cox regression model were used to determine if the nutritional status at admission independently impacted mortality at one month. Results. The prevalence of malnourishment by SGA in our study was 67.3% among 395 hospitalized patients, of which 155 patients (39.2%) were moderately malnourished, and 111 (28.1%) were severely malnourished. Of 395 patients, 61 patients (15.4%) expired, of which 30 died in the hospital, and 31 died within 1 month of discharge from hospital. On univariate analysis, malnourished patients had significantly higher morality (24.3% in 111 Cat C patients) than well-nourished patients (10.1% in 129 Cat A patients), with OR 9.17, p-value 0.007. On multivariate logistic regression, age and higher Charlson Comorbidity Index (CCI) were independently associated with mortality. Higher CCI indicates higher burden of comorbidities on admission, and the CCI in the expired patient group (mean=4.38) was significantly higher than that of the alive cohort (mean=2.85). Though malnutrition significantly contributed to higher mortality on univariate analysis, it was not an independent predictor of outcome on multivariate logistic regression. Length of hospitalisation was also longer in the malnourished group (mean= 9.4 d) compared to the well-nourished group (mean= 8.03 d) with a trend towards significance (p=0.061). None of the anthropometric measurements like BMI, MUAC, or TSF showed any association with mortality or length of hospitalisation. Inference. The results of our study highlight the issue of hospital malnutrition in medicine wards and reiterate that malnutrition contributes significantly to patient outcomes. We found that SGA performs better than anthropometric measurements in assessing under-nutrition. We are of the opinion that the heterogeneity of the study population by diagnosis was probably the primary reason why malnutrition by SGA was not found to be an independent risk factor for mortality. Strategies to identify high-risk patients at admission and treat malnutrition in the hospital and post-discharge are needed.

Keywords: hospitalization outcome, length of hospital stay, mortality, malnutrition, subjective global assessment (SGA)

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Authors: Hassan Shahmiri Barzoki

Abstract:

Background: Posttraumatic stress disorder (PTSD) is an abnormal physiologic and psychological reaction in person with severe traumatic history. In recent studies, the relationship between PTSD and some other disease apparently unrelated to psychological situations, such as cardiovascular diseases, diabetes, and metabolic syndrome, has been revealed. Thus, the aim of this study was to survey the prevalence of metabolic syndrome and mental health in PTSD patients. Methods: The research design was retrospective cohort study. Subjects were consisted of 142 Iran-Iraq war veterans with PTSD (age: 40-60 years), and the control group was consisted of 153 veterans without PTSD. Data was collected using questionnaires, physical exams and laboratory tests. Results: Prevalence of metabolic syndrome was 45.1%in PTSD group and 17% in control group. In addition, blood pressure, triglyceride and fasting blood sugar in PTSD group were significantly higher than control group (p<0.05). Also, PTSD patients had significant high rates of psychiatric disorders. Conclusion: PTSD patients are more prone to metabolic syndrome and psychiatric disorders than control group.

Keywords: mental health, metabolic syndrome, post traumatic stress disorder, patient

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Authors: Ju-Young Hwang, Hyo-Gyoung Kwak

Abstract:

This paper introduces a numerical analysis method for reinforced-concrete (RC) structures exposed to fire and compares the result with experimental results. The proposed analysis method for RC structure under the high temperature consists of two procedures. First step is to decide the temperature distribution across the section through the heat transfer analysis by using the time-temperature curve. After determination of the temperature distribution, the nonlinear analysis is followed. By considering material and geometrical nonlinearity with the temperature distribution, nonlinear analysis predicts the behavior of RC structure under the fire by the exposed time. The proposed method is validated by the comparison with the experimental results. Finally, prediction model to describe the status of after-cooling concrete can also be introduced based on the results of additional experiment. The product of this study is expected to be embedded for smart structure monitoring system against fire in u-City.

Keywords: RC, high temperature, after-cooling analysis, nonlinear analysis

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Authors: Syed Ahzam Tariq, Atharva Modi

Abstract:

This paper presents a probabilistic analysis of the safety of water tube boilers using fault tree analysis (FTA). A fault tree has been constructed by considering all possible areas where a malfunction could lead to a boiler accident. Boiler accidents are relatively rare, causing a scarcity of data. The fuzzy approach is employed to perform a quantitative analysis, wherein theories of fuzzy logic are employed in conjunction with expert elicitation to calculate failure probabilities. The Fuzzy Fault Tree Analysis (FFTA) provides a scientific and contingent method to forecast and prevent accidents.

Keywords: fault tree analysis water tube boiler, fuzzy probability score, failure probability

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Authors: Amruta D. S. Pathare, Indira Hinduja, Kusum Zaveri

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Implantation failure (IF) even after the good-quality embryo transfer (ET) in the physiologically normal endometrium is the main obstacle in in vitro fertilization (IVF). Various microarray studies have been performed worldwide to elucidate the genes requisite for endometrial receptivity. These studies have included the population based on different phases of menstrual cycle during natural cycle and stimulated cycle in normal fertile women. Additionally, the literature is also available in recurrent implantation failure patients versus oocyte donors in natural cycle. However, for the first time, we aim to study the genomics of endometrial receptivity in IF patients under controlled ovarian stimulation (COS) during which ET is generally practised in IVF. Endometrial gene expression profiling in IF patients (n=10) and oocyte donors (n=8) were compared during window of implantation under COS by whole genome microarray (using Illumina platform). Enrichment analysis of microarray data was performed to determine dys-regulated biological functions and pathways using Database for Annotation, Visualization and Integrated Discovery, v6.8 (DAVID). The enrichment mapping was performed with the help of Cytoscape software. Microarray results were validated by real-time PCR. Localization of genes related to immune response (Progestagen-Associated Endometrial Protein (PAEP), Leukaemia Inhibitory Factor (LIF), Interleukin-6 Signal Transducer (IL6ST) was detected by immunohistochemistry. The study revealed 418 genes downregulated and 519 genes upregulated in IF patients compared to healthy fertile controls. The gene ontology, pathway analysis and enrichment mapping revealed significant downregulation in activation and regulation of immune and inflammation response in IF patients under COS. The lower expression of Progestagen Associated Endometrial Protein (PAEP), Leukemia Inhibitory Factor (LIF) and Interleukin 6 Signal Transducer (IL6ST) in cases compared to controls by real time and immunohistochemistry suggests the functional importance of these genes. The study was proved useful to uncover the probable reason of implantation failure being imbalance of immune and inflammatory regulation in our group of subjects. Based on the present study findings, a panel of significant dysregulated genes related to immune and inflammatory pathways needs to be further substantiated in larger cohort in natural as well as stimulated cycle. Upon which these genes could be screened in IF patients during window of implantation (WOI) before going for embryo transfer or any other immunological treatment. This would help to estimate the regulation of specific immune response during WOI in a patient. The appropriate treatment of either activation of immune response or suppression of immune response can be then attempted in IF patients to enhance the receptivity of endometrium.

Keywords: endometrial receptivity, immune and inflammatory response, gene expression microarray, window of implantation

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Authors: Rebecca M. Dagger, Katy Hadgraft, Matthew Teggart, Peter Angell

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Background: There is a growing body of evidence that demonstrates the association between sedentary behaviour, cardiometabolic risk and all-cause mortality. Since full time working adults spend approximately 8 hours per day in the workplace, interventions to reduce sedentary behaviour at work may alleviate some of the negative health outcomes associated with sedentary behaviour. The aims of this pilot study were to assess the impacts of using a Sit-Stand workstation on markers of cardiometabolic health in a cohort of desk workers. Methods: Twenty eight participants were recruited and randomly assigned to a control (n=5 males, 9 females, mean age 37 years ± 9.4 years) or intervention group (n= 5 males, 9 females, mean age 42 years ± 12.7 years). All participants attended the labs on 2 occasion’s pre and post intervention, following baseline measurements the intervention participants had the Sit Stand Workstations (Ergotron, USA) installed for a 10 week intervention period. The Sit Stand workstations allow participants to stand or sit at their usual workstation and participants were encouraged to the use the desk in a standing position at regular intervals throughout the working day. Cardiometabolic risk markers assessed were body mass, body composition (using bio impedance analysis; Tanita, Tokyo), fasting blood Total Cholesterol (TC), lipid profiles (HDL-C, LDL-C, TC: HDL-C ratio), triglycerides and fasting glucose (Cholestech LDX), resting systolic and diastolic blood pressure and resting heart rate. ANCOVA controlling for baseline values was used to assess the group difference in changes in risk markers between pre and post intervention. Results: The 10 week intervention was associated with significant reductions in some cardiometabolic risk factors. There were significant group effects on change in body mass (F (1,25)=5.915, p<0.05), total body fat percentage (F(1,25)=12.615, p<0.01), total fat mass (F (1,25)=6.954, p<0.05), and systolic blood pressure (F (1,25)=5.012, p<0.05). There were no other significant group effects on changes in other cardiometabolic risk markers. Conclusion: This pilot study highlights the importance of reducing sedentary behaviour in the workplace for reduction in cardiometabolic risk markers. Further research is required to support these findings.

Keywords: sedentary behaviour, caridometabolic risk, evidence, risk makers

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Authors: Amin Masoumiganjgah, Luke Salmon, Julianne Burnton, Fahimeh Bagheri, Gavin Lenton, S. L. Ezekial Tan

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Introduction: The incidence of proximal biceps tenodesis and acute distal biceps repair is increasing, and rehabilitation protocols following both are variable. Golf is a popular sport within Australia, and the Gold Coast has become a Mecca for golfers, with more courses per capita than anywhere else in the world. Currently, there are no clear guidelines regarding return to golf play following biceps procedures. The aim of this study was to determine biceps brachii activation during the golf swing through electromyographic analysis, and subsequently, aid in rehabilitation guidelines and return to golf following tenodesis and repair. Methods: Subjects were amateur golfers with no previous upper limb surgery. Surface electromyography (EMG) and high-speed video recording were used to analyse activation of the left and right biceps brachii and the anterior deltoid during the golf swing. Each participant’s maximum voluntary contraction (MVC) was recorded, and they were then required to hit a golf ball aiming for specific distances of 2, 50, 100 and 150 metres at a driving range. Noraxon myoResearch and Matlab were used for data analysis. Mean % MVC was calculated for leading and trailing arms during the full swing and its’ 4 phases: back-swing, acceleration, early follow-through and late follow-through. Results: 12 golfers (2 female and 10 male), participated in the study. Median age was 27 (25 – 38), with all being right handed. Over all distances, the mean activation of the short and long head of biceps brachii was < 10% through the full swing. When breaking down the 50, 100 and 150m swing into phases, mean MVC activation was lowest in backswing (5.1%), followed by acceleration (9.7%), early follow-through (9.2%), and late follow-through (21.4%). There was more variation and slightly higher activation in the right biceps (trailing arm) in backswing, acceleration, and early follow-through; with higher activation in the leading arm in late follow-through (25.4% leading, 17.3% trailing). 2m putts resulted in low MVC values (3.1% ) with little variation across swing phases. There was considerable individual variation in results – one tense subject averaged 11.0% biceps MVC through the 2m putting stroke and others recorded peak mean MVC biceps activations of 68.9% at 50m, 101.3% at 100m, and 111.3% at 150m. Discussion: Previous studies have investigated the role of rotator cuff, spine, and hip muscles during the golf swing however, to our knowledge, this is the first study that investigates the activation of biceps brachii. Many rehabilitation programs following a biceps tenodesis or repair allow active range against gravity and restrict strengthening exercises until 6 weeks, and this does not appear to be associated with any adverse outcome. Previous studies demonstrate a range of < 10% MVC is similar to the unloaded biceps brachii during walking(1), active elbow flexion with the hand positioned either in pronation or supination will produce MVC < 20% throughout range(2) and elbow flexion with a 4kg dumbbell can produce mean MVC’s of around 40%(3). Our study demonstrates that increasing activation is associated with the leading arm, increasing shot distance and the late follow-through phase. Although the cohort mean MVC of the biceps brachii is <10% through the full swing, variability is high and biceps activation reach peak mean MVC’s of over 100% in different swing phases for some individuals. Given these EMG values, caution is advised when advising patients post biceps procedures to return to long distance golf shots, particularly when the leading arm is involved. Even though it would appear that putting would be as safe as having an unloaded hand out of a sling following biceps procedures, the variability of activation patterns across different golfers would lead us to caution against accelerated golf rehabilitation in those who may be particularly tense golfers. The 50m short iron shot was too long to consider as a chip shot and more work can be done in this area to determine the safety of chipping.

Keywords: electromyographic analysis, biceps brachii rupture, golf swing, tendon surgery

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Authors: Emma Whewell, Lee Waters, Mark Wall

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This paper is a mixed methods investigation into the perceived barriers to attainment and progression. Initially entry level data was analysed to identify some of the key characteristics of the student cohort- for example entry route, age and ethnic background. Secondly, a phenomenological case study of the lived experiences of 15 level 5 sport and exercise students was conducted. It aimed to understand the complexities of success in higher education, far beyond entry qualifications, indices of deprivation and POLAR characteristics, to offer a first-hand account of student perceptions and interpretations of the barriers they face in progression, retention and completion on their programme. Using focus groups and interviews with students from a range of indices we offer a set of rich case studies exploring the interpretations of our students’ lived experiences and challenges. Findings demonstrate a complex set of circumstances that centre on managing workload, use of support services and aspirations of students that conflict with university priorities. Conclusions centre on the role of academic and pastoral support, assumptions about priorities of students and practical interventions to support achievement.

Keywords: access and participation, higher education, progression and retention, barriers

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Authors: Arman Kishan, Sanjay Kubsad, Steve Li, Mark Haft, Duc Nguyen, Dawn Laporte

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Objective: Carpal tunnel syndrome can be managed surgically with endoscopic or open carpal tunnel release (CTR). Rheumatoid arthritis (RA) is a known risk factor for Carpal Tunnel Syndrome (CTS) and is believed to be related to compression of the median nerve secondary to inflammation. We aimed to analyze national trends, outcomes, and patient-specific comorbidities associated with ECTR and OCTR in patients with RA. Methods: A retrospective cohort study was conducted using the PearlDiver database, identifying 683 RA patients undergoing ECTR and 4234 undergoing OCTR between 2010 and 2014. Demographic data, comorbidities, and complication rates were analyzed. Univariate and multivariable analyses assessed differences between the treatment methods. Results:  Patients with RA undergoing ECTR in comparison to OCTR had no significant differences in medical comorbidities such as hypertension, obesity, chronic kidney disease, hypothyroidism and diabetes mellitus. Patients in the ECTR group reported a risk ratio of 1.44 (95%CI: 1.10-1.89, p=0.01) of requiring repeat procedures within 90 days of the initial procedure. Five-year trends in ECTR and OCTR procedures reported a combined annual growth rate of 5.6% and 13.15, respectively. Conclusion: Endoscopic and open approaches to CTR are important considerations in surgical planning. RA and ECTR have previously been identified as independent risk factors for revision CTR. Our study has identified the 90-day risk of repeat procedures to be elevated in the ECTR group in comparison to the OCTR group. Additionally, the growth of OCTR procedures has outpaced the growth of ECTR procedures in the same period, likely in response to the trend of ECTR leading to higher rates of repeat procedures. The need for revision following ECTR in patients with RA could be related to chronic inflammation leading to transverse carpal ligament thickening and concomitant tenosynovitis. Future directions could include further characterization of repeat procedures performed in this subset of patients. 

Keywords: endoscopic treatment of carpal tunnel syndrome, open treatment of carpal tunnel syndrome, rheumatoid arthritis, trends analysis, carpal tunnel syndrome

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Authors: Arunas Emeljanovas, Brigita Mieziene, Tomas Venckunas

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Background statement: Level of aerobic capacity in school age children provides important information about the current and future cardiovascular, skeletal and mental health. It is widely recognised that risk factors for modern chronic diseases of the adults have their origins in childhood and adolescence. The aim of the study was to analyse the trends of aerobic capacity across decades within groups of gender and age. Methods. The research included data of participants from the three nationally representative cohort studies performed in Lithuania in the years 1992, 2002 and 2012 among 11 to 18-years-old school children. Total of 18,294 school children were recruited for testing. Only those who had their body weight and height measured and completed 20 m shuttle endurance test were included in the analysis. The total number of students included in the analyses was 15,213 (7608 boys and 7605 girls). The permission to conduct the study was obtained from the Lithuanian Bioethics Committee (permission number BE-2-45). Major findings: Results are performed across gender and age groups. The comparison of shuttle endurance test, controlling for body mass index, indicated that in general there is a constant decrease of aerobic capacity across decades in both genders and age groups. The deterioration in aerobic capacity in boys accounted for 17 to 43 percent across age groups within decades. The biggest decrease was in 14 years-old boys. The deterioration in girls accounted for 19 to 37 percent across age groups with the highest decrease in 11 years-old girls. Though, girls had lower levels of aerobic capacity through all age groups and across three decades. Body mass index, as a covariate, accounted for up to six percent in deterioration of aerobic capacity. Final statement: The detected relationships may reflect the level and pattern of engagement in physical activity and sports where increased activity associates with superior performance in the tests because of the upregulated physiological function and instigated competitive/motivational level. The significance of the decade indirectly supports the importance of the recently changed activity among schoolchildren for this relationship.

Keywords: aerobic capacity, cardiovascular health, endurance, school age children

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Authors: Michael McMahon

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The use of media (video/animation/graphics) has long been used by athletes, coaches, and sports scientists to analyse and improve performance in technical skills and team tactics. Sports educators are increasingly open to the use of technology to support coach and learner development. However, an overreliance is a concern., This paper is part of a larger Ph.D. study looking into these new challenges for Sports Educators. Most notably, how to exploit the deep-learning potential of Digital Media among expert learners, how to instruct sports educators to create effective media content that fosters deep learning, and finally, how to make the process manageable and cost-effective. Central to the study is Richard Mayers Cognitive Theory of Multimedia Learning. Mayers Multimedia Learning Theory proposes twelve principles that shape the design and organization of multimedia presentations to improve learning and reduce cognitive load. For example, the Prior Knowledge principle suggests and highlights different learning outcomes for Novice and Non-Novice learners, respectively. Little research, however, is available to support this principle in modified domains (e.g., sports tactics and strategy). As a foundation for further research, this paper compares and contrasts a range of contemporary multimedia sports coaching content and assesses how they perform as learning tools for Strategic and Tactical Play Acquisition among elite sports practitioners. The stress tests applied are guided by Mayers's twelve Multimedia Learning Principles. The focus is on the elite athletes and whether current coaching digital media content does foster improved sports learning among this cohort. The sport of Gaelic Football was selected as it has high strategic and tactical play content, a wide range of Practitioner skill levels (Novice to Elite), and also a significant volume of Multimedia Coaching Content available for analysis. It is hoped the resulting data will help identify and inform the future instructional content design and delivery for Sports Practitioners and help promote best design practices optimal for different levels of expertise.

Keywords: multimedia learning, e-learning, design for learning, ICT

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Authors: Jin-Ming Wu, Te-Wei Ho, Yu-Wen Tien

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Background: The aim of this population-based study was to determine the occurrence of diabetes and exocrine pancreatic insufficiencies (EPI) on non-diabetes subjects receiving distal pancreatectomy (DP). Method: A nationwide cohort study between 2000 and 2010 was collected from the Taiwan National Health Insurance Research Database. Among 3264 DP patients, we identified 1410 non-diabetes and 966 non-diabetes non-EPI. Results. Of 1410 non-diabetes DP subjects, 312 patients (22.1%) developed newly-diagnosed diabetes after PD. On a multiple logistic regression model, co-morbid hyperlipidemia (odds ratio, 1.640; 95% CI, 1.362–2.763; P < 0.001) and pancreatitis (odds ratio, 2.428; 95% CI, 1.889–3.121; P < 0.001) significantly contributed to higher incidences of diabetes after DP. Moreover, 380 subjects (39.3%) developed EPI, and pancreatic cancer is the statistically significant risk factor (odds ratio, 4.663; 95% CI, 2.108–6.085; P < 0.001). Conclusion: The patients with co-morbid hyperlipidemia and chronic pancreatitis had higher rates of newly-diagnosed diabetes after DP, moreover, pancreatic cancer subjects had higher rates of pancreatic exocrine insufficiency after DP. The clinicians should be alert to follow up glucose metabolism and clinical symptoms of fat intolerance for DP patients.

Keywords: distal pancreatectomy, National database, diabetes, exocrine insufficiency

Procedia PDF Downloads 181

Authors: Xiaodong Li, Peng Gao, Chao-Jung Huang, Shiying Hao, Xuefeng B. Ling, Yongxia Han, Yaqi Zhang, Le Zheng, Chengyin Ye, Modi Liu, Minjie Xia, Changlin Fu, Bo Jin, Karl G. Sylvester, Eric Widen

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Predicting the risk of Pancreatic Adenocarcinoma (PA) in advance can benefit the quality of care and potentially reduce population mortality and morbidity. The aim of this study was to develop and prospectively validate a risk prediction model to identify patients at risk of new incident PA as early as 3 months before the onset of PA in a statewide, general population in Maine. The PA prediction model was developed using Deep Neural Networks, a deep learning algorithm, with a 2-year electronic-health-record (EHR) cohort. Prospective results showed that our model identified 54.35% of all inpatient episodes of PA, and 91.20% of all PA that required subsequent chemoradiotherapy, with a lead-time of up to 3 months and a true alert of 67.62%. The risk assessment tool has attained an improved discriminative ability. It can be immediately deployed to the health system to provide automatic early warnings to adults at risk of PA. It has potential to identify personalized risk factors to facilitate customized PA interventions.

Keywords: cancer prediction, deep learning, electronic health records, pancreatic adenocarcinoma

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Authors: Khaled M. Alqahtani

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Copy number alterations (CNA) are variations in the structure of the genome, where certain regions deviate from the typical two chromosomal copies. These alterations are pivotal in understanding tumor progression and are indicative of patients' survival outcomes. However, effectively modeling patients' survival based on their genomic CNA profiles while identifying relevant genomic regions remains a statistical challenge. Various methods, such as the Cox proportional hazard (PH) model with ridge, lasso, or elastic net penalties, have been proposed but often overlook the inherent dependencies between genomic regions, leading to results that are hard to interpret. In this study, we enhance the elastic net penalty by incorporating an additional penalty that accounts for these dependencies. This approach yields smooth parameter estimates and facilitates variable selection, resulting in a sparse solution. Our findings demonstrate that this method outperforms other models in predicting survival outcomes, as evidenced by our simulation study. Moreover, it allows for a more meaningful interpretation of genomic regions associated with patients' survival. We demonstrate the efficacy of our approach using both real data from a lung cancer cohort and simulated datasets.

Keywords: copy number alterations, cox proportional hazard, lung cancer, regression, sparse solution

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