Search results for: optimized criteria

Authors: Aleksandra Szurlej-Kielanska, Lucyna Pilacka, Dariusz Górecki

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The dynamic development of wind energy requires the simultaneous implementation of effective systems minimizing the risk of collisions between birds and wind turbines. Wind turbines are installed in more and more challenging locations, often close to the natural environment of birds. More and more countries and organizations are defining guidelines for the necessary functionality of such systems. The minimum bird detection distance, trajectory tracking, and shutdown time are key factors in eliminating collisions. Since 2020, we have continued the survey on the validation of the subsequent version of the BPS detection and reaction system. Bird protection system (BPS) is a fully automatic camera system which allows one to estimate the distance of the bird to the turbine, classify its size and autonomously undertake various actions depending on the bird's distance and flight path. The BPS was installed and tested in a real environment at a wind turbine in northern Poland and Central Spain. The performed validation showed that at a distance of up to 300 m, the BPS performs at least as well as a skilled ornithologist, and large bird species are successfully detected from over 600 m. In addition, data collected by BPS systems installed in Spain showed that 60% of the detections of all birds of prey were from individuals approaching the turbine, and these detections meet the turbine shutdown criteria. Less than 40% of the detections of birds of prey took place at wind speeds below 2 m/s while the turbines were not working. As shown by the analysis of the data collected by the system over 12 months, the system classified the improved size of birds with a wingspan of more than 1.1 m in 90% and the size of birds with a wingspan of 0.7 - 1 m in 80% of cases. The collected data also allow the conclusion that some species keep a certain distance from the turbines at a wind speed of over 8 m/s (Aquila sp., Buteo sp., Gyps sp.), but Gyps sp. and Milvus sp. remained active at this wind speed on the tested area. The data collected so far indicate that BPS is effective in detecting and stopping wind turbines in response to the presence of birds of prey with a wingspan of more than 1 m.

Keywords: protecting birds, birds monitoring, wind farms, green energy, sustainable development

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Authors: Dina Jalalvand, Joshua A. Cleland

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This double-blind, randomized control trial with parallel groups aimed to examine the effectiveness of office-based occupational therapy for office workers with low back pain on the intensity of pain and range of motion. Seventy-two male office workers (age: 20-50 years) with chronic low back pain (more than three months with at least two symptoms of chronic low back pain) satisfied eligibility criteria and agreed to participate in this study. The absence of joint burst following magnetic resonance imagining (MRI) was considered as an important inclusion criterion as well. Subjects were randomly assigned to a control or experimental group. The experimental group received the modified package of exercise-based occupational therapy, which included 11 simple exercise movements (derived from Williams and McKenzie), and the control group just received the conventional therapy, which included their routine physiotherapy sessions. The subjects completed the exercises three times a week for a duration of six weeks. Each exercise session was 10-15 minutes. Pain intensity and range of motion were the primary outcomes and were measured at baseline, 6 weeks, and 12 weeks after the end of the intervention using the numerical rating scale (NRS) and goniometer accordingly. Repeated measure ANOVA was used for analyzing data. The results of this study showed that significant decreases in pain intensity (p ≤ 0.05) and an increase in range of motion (p ≤ 0.001) in the experimental group in comparison with the control group after 6 and 12 weeks of intervention (between-group comparisons). In addition, there was a significant decrease in intensity of the pain (p ≤ 0.05) and an increase (p ≤ 0.001) in range of motion in the intervention group in comparison with baseline after 6 and 12 weeks (within-group comparison). This showed a positive effect of exercise-based occupational therapy that could potentially be used with low cost among office workers who suffer from low back pain. In addition, it should be noted that the introduced package of exercise training is easy to do, and there is not a need for a specific introduction.

Keywords: public health, office workers, low back pain, occupational therapy

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Authors: Vilas Warudkar, Dinkar Janghel, Siraj Ahmed

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Rapid development experienced by India requires huge amount of energy. Actual supply capacity additions have been consistently lower than the targets set by the government. According to World Bank 40% of residences are without electricity. In 12th five year plan 30 GW grid interactive renewable capacity is planned in which 17 GW is Wind, 10 GW is from solar and 2.1 GW from small hydro project, and rest is compensated by bio gas. Renewable energy (RE) and energy efficiency (EE) meet not only the environmental and energy security objectives, but also can play a crucial role in reducing chronic power shortages. In remote areas or areas with a weak grid, wind energy can be used for charging batteries or can be combined with a diesel engine to save fuel whenever wind is available. India according to IEC 61400-1 belongs to class IV Wind Condition; it is not possible to set up wind turbine in large scale at every place. So, the best choice is to go for small scale wind turbine at lower height which will have good annual energy production (AEP). Based on the wind characteristic available at MANIT Bhopal, rotor for small scale wind turbine is designed. Various Aero foil data is reviewed for selection of airfoil in the Blade Profile. Airfoil suited of Low wind conditions i.e. at low Reynold’s number is selected based on Coefficient of Lift, Drag and angle of attack. For designing of the rotor blade, standard Blade Element Momentum (BEM) Theory is implanted. Performance of the Blade is estimated using BEM theory in which axial induction factor and angular induction factor is optimized using iterative technique. Rotor performance is estimated for particular designed blade specifically for low wind Conditions. Power production of rotor is determined at different wind speeds for particular pitch angle of the blade. At pitch 15o and velocity 5 m/sec gives good cut in speed of 2 m/sec and power produced is around 350 Watts. Tip speed of the Blade is considered as 6.5 for which Coefficient of Performance of the rotor is calculated 0.35, which is good acceptable value for Small scale Wind turbine. Simple Load Model (SLM, IEC 61400-2) is also discussed to improve the structural strength of the rotor. In SLM, Edge wise Moment and Flap Wise moment is considered which cause bending stress at the root of the blade. Various Load case mentioned in the IEC 61400-2 is calculated and checked for the partial safety factor of the wind turbine blade.

Keywords: annual energy production, Blade Element Momentum Theory, low wind Conditions, selection of airfoil

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Authors: Dammar Bahadur Adhikari

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Community forestry in Nepal has got disproportionately high level of support from government and other actors in forestry sector. Even though master plan for forestry sector (1989) has highlighted community and private forestry as one component, the government policies and other intervention deliberately left out private forestry in its structure and programs. The study aimed at providing the pathway for formulating appropriate policies to address need of different kind of forest management regimes in Rautahat district, Nepal. The key areas the research focused were assessment of current status of private forestry, community forest users' understanding on private forestry; criteria for choosing species of private forestry and factors affecting establishment of private forestry in the area. Qualitative and quantitative data were collected employing questionnaire survey, rapid forest assessment and key informant interview. The study found out that forest policies are imposed due to intense pressure of exogenous forces than due to endogenous demand. Most of the local people opine that their traditional knowledge and skills are not sufficient for private forestry and hence need training on the matter. Likewise, local use, market value and rotation dictate the choice of species for plantation in private forests. Currently district forest office is the only government institution working in the area of private forestry all other governmental and non-governmental organizations have condoned. private forestry. Similarly, only permanent settlers in the area are found to establish private forests other forest users such as migrants and forest encroachers follow opportunistic behavior to meet their forest product need from community and national forests. In this regard, the study recommends taking appropriate step to support other forest management system including private forestry provide community forestry the benefits of competition as suggested by Darwin in 18th century, one and half century back and to help alleviate poverty by channelizing benefits to household level.

Keywords: community forest, forest management, poverty, private forest, users’ group

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Authors: Kathryn L. Duncan, Charles A. Kuntz, Alessandra C. Santamaria, James O. Simcock

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Access to megavoltage radiation therapy for small animals is limited in many locations around the world. This can preclude the use of palliative radiation therapy for the treatment of appendicular osteosarcoma in dogs. The objective of this study was to retrospectively assess the adverse effects and survival times of dogs with appendicular osteosarcoma that were treated with hypofractionated orthovoltage radiation therapy and adjunctive carboplatin chemotherapy administered via a single subcutaneous infusion. Medical records were reviewed retrospectively to identify client-owned dogs with spontaneously occurring appendicular osteosarcoma that was treated with palliative orthovoltage radiation therapy and a single subcutaneous infusion of carboplatin. Data recorded included signalment, tumour location, results of diagnostic imaging, haematologic and serum biochemical analyses, adverse effects of radiation therapy and chemotherapy, and survival times. Kaplan-Meier survival analysis was performed, and log-rank analysis was used to determine the impact of specific patient variables on survival time. Twenty-three dogs were identified that met the inclusion criteria. Median survival time for dogs was 182 days. Eleven dogs had adverse haematologic effects, 3 had adverse gastrointestinal effects, 6 had adverse effects at the radiation site and 7 developed infections at the carboplatin infusion site. No statistically significant differences were identified in survival times based on sex, tumour location, development of infection, or pretreatment serum alkaline phosphatase. Median survival time and incidence of adverse effects were comparable to those previously reported in dogs undergoing palliative radiation therapy with megavoltage or cobalt radiation sources and conventional intravenous carboplatin chemotherapy. The use of orthovoltage palliative radiation therapy may be a reasonable alternative to megavoltage radiation in locations where access is limited.

Keywords: radiotherapy, veterinary oncology, chemotherapy, osteosarcoma

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Authors: Rawan A. Abdelrazeq, Ahmed M. Khalafallah, Nabil A. Kartam

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Selection of competent contractors for construction projects is usually accomplished through competitive bidding or negotiated contracting in which the contract bid price is the basic criterion for selection. The evaluation of contractor’s safety performance is still not a typical criterion in the selection process, despite the existence of various safety prequalification procedures. There is a critical need for practical and automated systems that enable owners and decision makers to evaluate contractor safety performance, among other important contractor selection criteria. These systems should ultimately favor safety-conscious contractors to be selected by the virtue of their past good safety records and current safety programs. This paper presents an exploratory sequential mixed-methods approach to develop a framework for an automated decision support system that evaluates contractor safety performance based on a multitude of indicators and metrics that have been identified through a comprehensive review of construction safety research, and a survey distributed to domain experts. The framework is developed in three phases: (1) determining the indicators that depict contractor current and past safety performance; (2) soliciting input from construction safety experts regarding the identified indicators, their metrics, and relative significance; and (3) designing a decision support system using relational database models to integrate the identified indicators and metrics into a system that assesses and rates the safety performance of contractors. The proposed automated system is expected to hold several advantages including: (1) reducing the likelihood of selecting contractors with poor safety records; (2) enhancing the odds of completing the project safely; and (3) encouraging contractors to exert more efforts to improve their safety performance and practices in order to increase their bid winning opportunities which can lead to significant safety improvements in the construction industry. This should prove useful to decision makers and researchers, alike, and should help improve the safety record of the construction industry.

Keywords: construction safety, contractor selection, decision support system, relational database

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Authors: Hervice Roméo Fogno Fotsoa, Germaine Djuidje Kenmoe, Claude Vidal Aloyem Kazé

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One of the main applications of machine learning is the prediction of time series. But a more accurate prediction requires a more optimal model of machine learning. Several optimization techniques have been developed, but without considering the input variables disposition of the system. Thus, this work aims to present a new machine learning architecture optimization technique based on their optimal input variables disposition. The validations are done on the prediction of wind time series, using data collected in Cameroon. The number of possible dispositions with four input variables is determined, i.e., twenty-four. Each of the dispositions is used to perform the prediction, with the main criteria being the training and prediction performances. The results obtained from a static architecture and a dynamic architecture of neural networks have shown that these performances are a function of the input variable's disposition, and this is in a different way from the architectures. This analysis revealed that it is necessary to take into account the input variable's disposition for the development of a more optimal neural network model. Thus, a new neural network training algorithm is proposed by introducing the search for the optimal input variables disposition in the traditional back-propagation algorithm. The results of the application of this new optimization approach on the two single neural network architectures are compared with the previously obtained results step by step. Moreover, this proposed approach is validated in a collaborative optimization method with a single objective optimization technique, i.e., genetic algorithm back-propagation neural networks. From these comparisons, it is concluded that each proposed model outperforms its traditional model in terms of training and prediction performance of time series. Thus the proposed optimization approach can be useful in improving the accuracy of time series forecasts. This proves that the proposed optimization approach can be useful in improving the accuracy of time series prediction based on machine learning.

Keywords: input variable disposition, machine learning, optimization, performance, time series prediction

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Authors: M. B. Ricardo De Oliveira, A. Borghi-Silva, E. Paravizo, F. Lizarelli, L. Di Thomazzo, D. Braatz

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Prototypes are a critical feature in the product development process, as they help the project team visualize early concept flaws, communicate ideas and introduce an initial product testing. Involving stakeholders, such as consumers and users, in prototype tests allows the gathering of valuable feedback, contributing for a better product and making the design process more participatory. Even though recent studies have shown that user evaluation of prototypes is valuable, few articles provide a method or protocol on how designers should conduct it. This multidisciplinary study (involving the areas of physiotherapy, engineering and computer science) aims to develop an evaluation protocol, using an ergometric step prototype as the product prototype to be assessed. The protocol consisted of performing two tests (the 2 Minute Step Test and the Portability Test) to allow users (patients) and consumers (physiotherapists) to have an experience with the prototype. Furthermore, the protocol contained four Likert-Scale questionnaires (one for users and three for consumers), that inquired participants about how they perceived the design characteristics of the product (performance, safety, materials, maintenance, portability, usability and ergonomics), in their use of the prototype. Additionally, the protocol indicated the need to conduct interviews with the product designers, in order to link their feedback to the ones from the consumers and users. Both tests and interviews were recorded for further analysis. The participation criteria for the study was gender and age for patients, gender and experience with 2 Minute Step Test for physiotherapists and involvement level in the product development project for designers. The questionnaire's reliability was validated using Cronbach's Alpha and the quantitative data of the questionnaires were analyzed using non-parametric hypothesis tests with a significance level of 0.05 (p <0.05) and descriptive statistics. As a result, this study provides a concise evaluation protocol which can assist designers in their development process, collecting quantitative feedback from consumer and users, and qualitative feedback from designers.

Keywords: Product Design, Product Evaluation, Prototypes, Step

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Authors: Shizrah Jamal, Robia Ghafoor, Farhan Raza

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Porcelain fused to metal crown is the most versatile variety of crown that is commonly placed worldwide. Various complications have been reported in the PFM crowns with use over the period of time. These include chipping of the porcelain, recurrent caries, loss of retention, open contacts, and tooth fracture. The objective of the present study was to determine the frequency of these complications in crowns cemented over a period of five years in a tertiary care hospital and also to report the survival of these crowns. A retrospective study was conducted in Dental clinics, Aga Khan University Hospital in which 150 PFM crowns cemented over a period of five years were evaluated. Patient demographics, oral hygiene habits, para-functional habits, crown insertion and follow-up dates were recorded in a specially designed proforma. All PFM crowns fulfilling the inclusion criteria were assessed both clinically and radiographically for the presence of any complication. SPSS version 22.0 was used for statistical analysis. Frequency distribution and proportion of complications were determined. Chi-square test was used to determine the association of complications of PFM crowns with multiple variables including tooth wear, opposing dentition and betel nut chewing. Kaplan- meier survival analysis was used to determine the survival of PFM crowns over the period of five years. Level of significance was kept at 0.05. A total of 107 patients, with a mean age of 43.51 + 12.4 years, having 150 PFM crowns were evaluated. The most common complication observed was open proximal contacts (8.7%) followed by porcelain chipping (6%), decementation (5.3%), and abutment fracture (1.3%). Chi square test showed that there was no statistically significant association of PFM crown complication with tooth wear, betel nut and opposing dentition (p-value <0.05). The overall success and survival rates of PFM crowns turned out to be 78.7 and 84.7% respectively. Within the limitations of the study, it can be concluded that PFM crowns are an effective treatment modality with high success and survival rates. Since it was a single centered study; the results should be generalized with caution.

Keywords: chipping, complication, crown, survival rate

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Authors: Syeda Sahra, Abdullah Jahangir, Rachelle Hamadi, Ahmad Jahangir, Allison Glaser

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Background: Antimicrobial resistance is on the rise. The use of redundant and inappropriate antibiotics is contributing to recurrent infections and resistance. Newer antibiotics with more robust coverage for gram-negative bacteria are in great demand for complicated urinary tract infections (cUTIs), complicated intra-abdominal infections (cIAIs), hospital-acquired bacterial pneumonia (H.A.B.P.), and ventilator-associated bacterial pneumonia (V.A.B.P.). Objective: We performed this meta-analysis to evaluate the efficacy and safety profile of a new antibiotic, Imipenem/cilastatin/relebactam, compared to other broad-spectrum antibiotics for complicated infections. Search Strategy: We conducted a systemic review search on PubMed, Embase, and Central Cochrane Registry. Selection Criteria: We included randomized clinical trials (R.C.T.s) with the standard of care as comparator arm with Imipenem/cilastatin/relebactam as intervention arm. Analysis: For continuous variables, the mean difference was used. For discrete variables, we used the odds ratio. For effect sizes, we used a confidence interval of 95%. A p-value of less than 0.05 was used for statistical significance. Analysis was done using a random-effects model irrespective of heterogeneity. Heterogeneity was evaluated using the I2 statistic. Results: The authors observed similar efficacy at clinical and microbiologic response levels on early follow-up and late follow-up compared to the established standard of care. The incidence of drug-related adverse events, serious adverse events, and drug discontinuation due to adverse events were comparable across both groups. Conclusion: Imipenem/cilastatin/relebactam has a non-inferior safety and efficacy profile compared to peer antibiotics to treat severe bacterial infections (cUTIs, cIAIs, H.A.B.P., V.A.B.P.).

Keywords: bacterial pneumonia, complicated intra-abdominal infections, complicated urinary tract infection, Imipenem, cilastatin, relebactam

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Authors: Ogbonnaya Elom, Francis N. Azunku, Ogochukwu Onah

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This study was carried out to determine the correlates of cost effectiveness analysis of rating scale and psycho-productive multiple choice test for assessing students’ performance in rice production. Four research questions were developed and answered, while one hypothesis was formulated and tested. Survey and correlation designs were adopted. The population of the study was 20,783 made up of 20,511 senior secondary (SSII) students and 272 teachers of agricultural science from 221 public secondary schools. Two schools with one intact class of 30 students each was purposely selected as sample based on certain criteria. Four sets of instruments were used for data collection. One of the instruments-the rating scale, was subjected to face and content validation while the other three were subjected to face validation only. Cronbach alpha technique was utilized to determine the internal consistency of the rating scale items which yielded a coefficient of 0.82 while the Kudder-Richardson (K-R 20) formula was involved in determining the stability of the psycho-productive multiple choice test items which yielded a coefficient of 0.80. Method of data collection involved a step-by-step approach in collecting data. Data collected were analyzed using percentage, weighted mean and sign test to answer the research questions while the hypothesis was tested using Spearman rank-order of correlation and t-test statistic. Findings of the study revealed among others, that psycho-productive multiple choice test is more effective than rating scale when the former is applied on the two groups of students. It was recommended among others, that the external examination bodies should integrate the use of psycho- productive multiple choice test into their examination policy and direct secondary schools to comply with it.

Keywords: correlates, cost-effectiveness, psycho-productive multiple-choice scale, rating scale

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Authors: Esra Zengin, Sinan Akkar

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Reliable and accurate prediction of nonlinear structural response requires specification of appropriate earthquake ground motions to be used in nonlinear time history analysis. The current research has mainly focused on selection and manipulation of real earthquake records that can be seen as the most critical step in the performance based seismic design and assessment of the structures. Utilizing amplitude scaled ground motions that matches with the target spectra is commonly used technique for the estimation of nonlinear structural response. Representative ground motion ensembles are selected to match target spectrum such as scenario-based spectrum derived from ground motion prediction equations, Uniform Hazard Spectrum (UHS), Conditional Mean Spectrum (CMS) or Conditional Spectrum (CS). Different sets of criteria exist among those developed methodologies to select and scale ground motions with the objective of obtaining robust estimation of the structural performance. This study presents ground motion selection and scaling procedure that considers the spectral variability at target demand with the level of ground motion dispersion. The proposed methodology provides a set of ground motions whose response spectra match target median and corresponding variance within a specified period interval. The efficient and simple algorithm is used to assemble the ground motion sets. The scaling stage is based on the minimization of the error between scaled median and the target spectra where the dispersion of the earthquake shaking is preserved along the period interval. The impact of the spectral variability on nonlinear response distribution is investigated at the level of inelastic single degree of freedom systems. In order to see the effect of different selection and scaling methodologies on fragility curve estimations, results are compared with those obtained by CMS-based scaling methodology. The variability in fragility curves due to the consideration of dispersion in ground motion selection process is also examined.

Keywords: ground motion selection, scaling, uncertainty, fragility curve

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Authors: Wann-Ming Wey

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In recent years, in addition to face the external threats such as energy shortages and climate change, traffic congestion and environmental pollution have become anxious problems for many cities. Considering private automobile-oriented urban development had produced many negative environmental and social impacts, the transit-oriented development (TOD) has been considered as a sustainable urban model. TOD encourages public transport combined with friendly walking and cycling environment designs, however, non-motorized modes help improving human health, energy saving, and reducing carbon emissions. Due to environmental changes often affect the planners’ decision-making; this research applies dynamic network process (DNP) which includes the time dependent concept to promoting friendly walking and cycling environmental designs as an advanced planning support system for environment improvements. This research aims to discuss what kinds of design strategies can improve a friendly walking and cycling environment under TOD. First of all, we collate and analyze environment designing factors by reviewing the relevant literatures as well as divide into three aspects of “safety”, “convenience”, and “amenity” from fifteen environment designing factors. Furthermore, we utilize fuzzy Delphi Technique (FDT) expert questionnaire to filter out the more important designing criteria for the study case. Finally, we utilized DNP expert questionnaire to obtain the weights changes at different time points for each design criterion. Based on the changing trends of each criterion weight, we are able to develop appropriate designing strategies as the reference for planners to allocate resources in a dynamic environment. In order to illustrate the approach we propose in this research, Taipei city as one example has been used as an empirical study, and the results are in depth analyzed to explain the application of our proposed approach.

Keywords: environment planning support systems, walking and cycling, transit-oriented development (TOD), dynamic network process (DNP)

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Authors: Suchhanda Ghosh, A. K. Paul

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Nickel, an industrially important metal is not mined in India, due to the lack of its primary mining resources. But, the chromite deposits occurring in the Sukinda and Baula-Nuasahi region of Odhisa, India, is reported to contain around 0.99% of nickel entrapped in the goethite matrix of the lateritic iron rich ore. Weathering of the dumped chromite mining overburden often leads to the contamination of the ground as well as the surface water with toxic nickel. Microbes inherent to this metal contaminated environment are reported to be capable of removal as well as detoxification of various metals including nickel. Nickel resistant fungal isolates obtained in pure form from the metal rich overburden were evaluated for their potential to biosorb nickel by using their dried biomass. Penicillium simplicissimum SAU203 was the best nickel biosorbant among the 20 fungi tested and was capable to sorbing 16.85 mg Ni/g biomass from a solution containing 50 mg/l of Ni. The identity of the isolate was confirmed using 18S rRNA gene analysis. The sorption capacity of the isolate was further standardized following Langmuir and Freundlich adsorption isotherm models and the results reflected energy efficient sorption. Fourier-transform infrared spectroscopy studies of the nickel loaded and control biomass in a comparative basis revealed the involvement of hydroxyl, amine and carboxylic groups in Ni binding. The sorption process was also optimized for several standard parameters like initial metal ion concentration, initial sorbet concentration, incubation temperature and pH, presence of additional cations and pre-treatment of the biomass by different chemicals. Optimisation leads to significant improvements in the process of nickel biosorption on to the fungal biomass. P. simplicissimum SAU203 could sorb 54.73 mg Ni/g biomass with an initial Ni concentration of 200 mg/l in solution and 21.8 mg Ni/g biomass with an initial biomass concentration of 1g/l solution. Optimum temperature and pH for biosorption was recorded to be 30°C and pH 6.5 respectively. Presence of Zn and Fe ions improved the sorption of Ni(II), whereas, cobalt had a negative impact. Pre-treatment of biomass with various chemical and physical agents has affected the proficiency of Ni sorption by P. simplicissimum SAU203 biomass, autoclaving as well as treatment of biomass with 0.5 M sulfuric acid and acetic acid reduced the sorption as compared to the untreated biomass, whereas, NaOH and Na₂CO₃ and Twin 80 (0.5 M) treated biomass resulted in augmented metal sorption. Hence, on the basis of the present study, it can be concluded that P. simplicissimum SAU203 has the potential for the removal as well as detoxification of nickel from contaminated environments in general and particularly from the chromite mining areas of Odhisa, India.

Keywords: nickel, fungal biosorption, Penicillium simplicissimum SAU203, Indian chromite mines, mining overburden

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Authors: Mei Sze Wong, Huanyu Mou, Wai-Tong Chien

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Background: Breastmilk is the most nutritious food for infants to support their growth and protect them from infection. Therefore, breastfeeding promotion is an important topic for infant health; whereas, different educational and supportive approaches to interventions have been prompted and targeted at antenatal, postnatal, or both periods to promote and sustain exclusive breastfeeding. This systematic review aimed to identify the effective approaches of educational and supportive interventions to improve breastfeeding. Outcome measures were exclusive breastfeeding, partial breastfeeding, and breastfeeding self-efficacy, being analyzed in terms of ≤ 2 months, 3-5 months, and ≥ 6 months postpartum. Method: Eleven electronic databases and the reference lists of eligible articles were searched. English or Chinese articles of randomized controlled trials on educational and supportive intervention with the above breastfeeding outcomes over recent 20 years were searched. Quality appraisal and risk of bias of the studies were checked by Effective Public Health Practice Project tool and Revised Cochrane risk-of-bias tool, respectively. Results: 13 articles that met the inclusion criteria were included; and they had acceptable quality and risk of bias. The optimal structure, format, and delivery of the interventions significantly increased exclusive breastfeeding rate at ≤ 2 months and ≥ 6 months and breastfeeding self-efficacy at ≤ 2 months included: (a) delivering from antenatal to postnatal period, (b) multicomponent involving antenatal group education, postnatal individual breastfeeding coaching and telephone follow-ups, (c) both individual and group basis, (d) being guided by self-efficacy theory, and (e) having ≥ 3 sessions. Conclusion: The findings showed multicomponent theory-based interventions with ≥ 3 sessions that delivered across antenatal and postnatal period; using both face-to-face teaching and telephone follow-ups can be useful to enhance exclusive breastfeeding rate for more than 6 months and breastfeeding self-efficacy over the first two months of postpartum.

Keywords: breastfeeding self-efficacy, education, exclusive breastfeeding, primiparous, support

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Authors: Miroslava Markovic, Snezana Rajkovic, Ljubinko Rakonjac, Aleksandar Lucic

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Oak powdery mildew is a serious problem on seedlings in nurseries as well as on naturally and artificially introduced progeny. The experiments were set on oak seedlings in two nurseries located in Central Serbia, where control of oak powdery mildew Microsphaera alphitoides Griff. et Maubl. had been conducted through alternative protection measures by means of various dosages of AQ-10 biofungicide, with and without added polymer (which has so far never been used in this country for control of oak powdery mildew). Simultaneous testing was conducted on the efficiency of a chemical sulphur-based preparation (used in this area for many years as a measure of suppression of powdery mildews, without the possibility of developing resistance of the pathogen to the active matter). To date, the Republic of Serbia has registered no fungicides for suppression of pathogens in the forest ecosystems. In order to introduce proper use of new disease-fighting agents into a country, certain relevant principles, requirements and criteria prescribed by the Forest Stewardship Council (FSC) must be observed, primarily with respect to measures of assessment and mitigation of risks, the list of dangerous and highly dangerous pesticides with the possibility of alternative protection. One of the main goals of the research was adjustment of the protective measures to the FSC policy through selection of eco-toxicologically favourable fungicides, given the fact that only preparations named on the list of permitted active matters are approved for use in certified forests. The results of the research have demonstrated that AQ-10 biofungicide can be used as a part of integrated disease management programmes as an alternative, through application of several treatments during vegetation and combination with other active matters registered for these purposes, so as to curtail the use of standard fungicides for control of powdery mildews on oak seedlings in nurseries. The best results in suppression of oak powdery mildew were attained through use of AQ-10 biofungicide (dose 50 or 70g/ha) with added polymer Nu Film-17 (dose 1.0 or 1.5 l/ha). If the treatment is applied at the appropriate time, even fewer number of treatments and smaller doses will be just as efficient.

Keywords: oak powdery mildew, biofungicides, polymers, Microsphaera alphitoides

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Authors: Allaire Eric, Hauet Pascal, Floresco Jean, Beley Sebastien, Sussman Helene, Virag Ronald

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Background: Caverno-venous leakage (CVL) is devastating, although barely known disease, the first cause of major physical impairment in men under 25, and responsible for 50% of resistances to phosphodiesterase 5-inhibitors (PDE5-I), affecting 30 to 40% of users in this medication class. In this condition, too early blood drainage from corpora cavernosa prevents penile rigidity and penetration during sexual intercourse. The role of conservative surgery in this disease remains controversial. Aim: Assess complications and results of combined open surgery and embolization for CVL. Method: Between June 2016 and September 2021, 133 consecutive patients underwent surgery in our institution for CVL, causing severe erectile dysfunction (ED) resistance to oral medical treatment. Procedures combined vein embolization and ligation with microsurgical techniques. We performed a pre-and post-operative clinical (Erection Harness Scale: EHS) hemodynamic evaluation by duplex sonography in all patients. Before surgery, the CVL network was visualized by computed tomography cavernography. Penile EMG was performed in case of diabetes or suspected other neurological conditions. All patients were optimized for hormonal status—data we prospectively recorded. Results: Clinical signs suggesting CVL were ED since age lower than 25, loss of erection when changing position, penile rigidity varying according to the position. Main complications were minor pulmonary embolism in 2 patients, one after airline travel, one with Factor V Leiden heterozygote mutation, one infection and three hematomas requiring reoperation, one decreased gland sensitivity lasting for more than one year. Mean pre-operative pharmacologic EHS was 2.37+/-0.64, mean pharmacologic post-operative EHS was 3.21+/-0.60, p<0.0001 (paired t-test). The mean EHS variation was 0.87+/-0.74. After surgery, 81.5% of patients had a pharmacologic EHS equal to or over 3, allowing for intercourse with penetration. Three patients (2.2%) experienced lower post-operative EHS. The main cause of failure was leakage from the deep dorsal aspect of the corpus cavernosa. In a 14 months follow-up, 83.2% of patients had a clinical EHS equal to or over 3, allowing for sexual intercourse with penetration, one-third of them without any medication. 5 patients had a penile implant after unsuccessful conservative surgery. Conclusion: Open surgery combined with embolization for CVL is an efficient approach to CVL causing severe erectile dysfunction.

Keywords: erectile dysfunction, cavernovenous leakage, surgery, embolization, treatment, result, complications, penile duplex sonography

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Authors: Allioua Meryem

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Similar to much of the developing world, Algeria is currently undergoing an epidemiological transition. While mal- and under-nutrition and infectious diseases used to be the main causes of poor health, today there is a higher proportion of chronic, non-communicable diseases (NCDs), including cardiovascular disease, diabetes mellitus, cancer, etc. According to estimates for Algeria from the World Health Organization (WHO), NCDs accounted for 63% of all deaths in 2010. The objective of this study was the assessment of eating habits and anthropometric characteristics in a group of youth aged 15 to 19 years in Tlemcen. This study was conducted on a total effective of 806 youth enrolled in a descriptive cross-sectional study; the classification of nutritional status has been established by international standards IOTF, youth were defined as obese if they had a BMI ≥ 95th percentile, and youth with 85th ≤ BMI ≤ 95th percentile were defined as overweight. Wc is classified by the criteria HD, Wc with moderate risk ≥ 90th percentile and Wc with high risk ≥ 95th percentile. The dietary assessment was based on a 24-hour dietary recall assisted by food records. USDA’S nutrient database for Nutrinux® program was used to analyze dietary intake. Nutrients adequacy ratio was calculated by dividing daily individual intake to dietary recommended intake DRI for each nutrient. 9% of the population was overweight, 3% was obese, 7.5% had abdominal obesity, foods eaten in moderation are chips, cookies, chocolate 1-3 times/day and increased consumption of fried foods in the week, almost half of youth consume sugary drinks more than 3 times per week, we observe a decreased intake of energy, protein (P < 0.001, P = 0.003), SFA (P = 0.018), the NAR of phosphorus, iron, magnesium, vitamin B6, vitamin E, folate, niacin, and thiamin reflecting less consumption of fruit, vegetables, milk, and milk products. Youth surveyed have eating habits at risk of developing obesity and chronic disease.

Keywords: food intake, health, anthropometric characteristics, Algeria

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Authors: Asma Omri, Noureddine Benothman, Sofiane Sayahi, Fethi Tlili, Hichem Besbes

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Cycling, a popular mode of transportation, can also be perilous due to cyclists' vulnerability to collisions with vehicles and obstacles. This paper presents an innovative cyclist safety system based on radar technology designed to offer real-time collision risk warnings to cyclists. The system incorporates a low-power radar sensor affixed to the bicycle and connected to a microcontroller. It leverages radar point cloud detections, a clustering algorithm, and a supervised classifier. These algorithms are optimized for efficiency to run on the TI’s AWR 1843 BOOST radar, utilizing a coarse classification approach distinguishing between cars, trucks, two-wheeled vehicles, and other objects. To enhance the performance of clustering techniques, we propose a 2-Level clustering approach. This approach builds on the state-of-the-art Density-based spatial clustering of applications with noise (DBSCAN). The objective is to first cluster objects based on their velocity, then refine the analysis by clustering based on position. The initial level identifies groups of objects with similar velocities and movement patterns. The subsequent level refines the analysis by considering the spatial distribution of these objects. The clusters obtained from the first level serve as input for the second level of clustering. Our proposed technique surpasses the classical DBSCAN algorithm in terms of geometrical metrics, including homogeneity, completeness, and V-score. Relevant cluster features are extracted and utilized to classify objects using an SVM classifier. Potential obstacles are identified based on their velocity and proximity to the cyclist. To optimize the system, we used the View of Delft dataset for hyperparameter selection and SVM classifier training. The system's performance was assessed using our collected dataset of radar point clouds synchronized with a camera on an Nvidia Jetson Nano board. The radar-based cyclist safety system is a practical solution that can be easily installed on any bicycle and connected to smartphones or other devices, offering real-time feedback and navigation assistance to cyclists. We conducted experiments to validate the system's feasibility, achieving an impressive 85% accuracy in the classification task. This system has the potential to significantly reduce the number of accidents involving cyclists and enhance their safety on the road.

Keywords: 2-level clustering, coarse classification, cyclist safety, warning system based on radar technology

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Authors: Liyun Chang, Cheng-Hsiang Tsai

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To ensure the radiation precisely delivering to the target of cancer patients, the linear accelerator equipped with the pretreatment on-board imaging system is introduced and through it the patient setup is verified before the daily treatment. New generation radiotherapy using beam-intensity modulation, usually associated the treatment with steep dose gradients, claimed to have achieved both a higher degree of dose conformation in the targets and a further reduction of toxicity in normal tissues. However, this benefit is counterproductive if the beam is delivered imprecisely. To avoid shooting critical organs or normal tissues rather than the target, it is very important to carry out the quality assurance (QA) of this on-board imaging system. The QA of the On-Board Imager® (OBI) system of one Varian Clinac-iX linear accelerator was performed through our procedures modified from a relevant report and AAPM TG142. Two image modalities, 2D radiography and 3D cone-beam computed tomography (CBCT), of the OBI system were examined. The daily and monthly QA was executed for five months in the categories of safety, geometrical accuracy and image quality. A marker phantom and a blade calibration plate were used for the QA of geometrical accuracy, while the Leeds phantom and Catphan 504 phantom were used in the QA of radiographic and CBCT image quality, respectively. The reference images were generated through a GE LightSpeed CT simulator with an ADAC Pinnacle treatment planning system. Finally, the image quality was analyzed via an OsiriX medical imaging system. For the geometrical accuracy test, the average deviations of the OBI isocenter in each direction are less than 0.6 mm with uncertainties less than 0.2 mm, while all the other items have the displacements less than 1 mm. For radiographic image quality, the spatial resolution is 1.6 lp/cm with contrasts less than 2.2%. The spatial resolution, low contrast, and HU homogenous of CBCT are larger than 6 lp/cm, less than 1% and within 20 HU, respectively. All tests are within the criteria, except the HU value of Teflon measured with the full fan mode exceeding the suggested value that could be due to itself high HU value and needed to be rechecked. The OBI system in our facility was then demonstrated to be reliable with stable image quality. The QA of OBI system is really necessary to achieve the best treatment for a patient.

Keywords: CBCT, image quality, quality assurance, OBI

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Authors: O. Elkana, O Heyman, S. Hamdan, M. Franko, J. Vatine

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Objective: To investigate whether a direct link exists between perceived pain (PP) and executive functions (EF), above and beyond the influence of depression symptoms, in the context of medical rehabilitation. Design: Cross-sectional study. Setting: Rehabilitation Hospital. Participants: 125 medical records of hospitalized patients were screened for matching to our inclusion criteria. Only 60 patients were found fit and were asked to participate. 19 decline to participate on personal basis. The 41 neurologically intact patients (mean age 46, SD 14.96) that participated in this study were in their sub-acute stage of recovery, with fluent Hebrew, with intact upper limb (to neutralize influence on psychomotor performances) and without an organic brain damage. Main Outcome Measures: EF were assessed using the Wisconsin Card Sorting Test (WCST) and the Stop-Signal Test (SST). PP was measured using 3 well-known pain questionnaires: Pain Disability Index (PDI), The Short-Form McGill Questionnaire (SF-MPQ) and the Pain Catastrophizing Scale (PCS). Perceived pain index (PPI) was calculated by the mean score composite from the 3 pain questionnaires. Depression symptoms were assessed using the Patient Health Questionnaire (PHQ-9). Results: The results indicate that irrespective of the presence of depression symptoms, PP is directly correlated with response inhibition (SST partial correlation: r=0.5; p=0.001) and mental flexibility (WSCT partial correlation: r=-0.37; p=0.021), suggesting decreased performance in EF as PP severity increases. High correlations were found between the 3 pain measurements: SF-MPQ with PDI (r=0.62, p<0.001), SF-MPQ with PCS (r=0.58, p<0.001) and PDI with PCS (r=0.38, p=0.016) and each questionnaire alone was also significantly associated with EF; thus, no specific questionnaires ‘pulled’ the results obtained by the general index (PPI). Conclusion: Examining the direct association between PP and EF, beyond the contribution of depression symptoms, provides further clinical evidence suggesting that EF and PP share underlying mediating neuronal mechanisms. Clinically, the importance of assessing patients' EF abilities as well as PP severity during rehabilitation is underscored.

Keywords: depression, executive functions, mental-flexibility, neuropsychology, pain perception, perceived pain, response inhibition

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Authors: Michal Brazda, Miroslav Urbanek, Martina Koukolikova

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This work focuses on the development of functional surfaces and edges for cutting and forming tools created through the Directed Energy Deposition (DED) technology. In the context of growing challenges in modern engineering, additive technologies, especially DED, present an innovative approach to manufacturing tools for forming and cutting. One of the key features of DED is its ability to precisely and efficiently deposit Fully dense metals from powder feedstock, enabling the creation of complex geometries and optimized designs. Gradually, it becomes an increasingly attractive choice for tool production due to its ability to achieve high precision while simultaneously minimizing waste and material costs. Tools created using DED technology gain significant durability through the utilization of high-performance materials such as nickel alloys and tool steels. For high-temperature applications, Nimonic 80A alloy is applied, while for cold applications, M2 tool steel is used. The addition of ceramic materials, such as tungsten carbide, can significantly increase the tool's resistance. The introduction of functionally graded materials is a significant contribution, opening up new possibilities for gradual changes in the mechanical properties of the tool and optimizing its performance in different sections according to specific requirements. In this work, you will find an overview of individual applications and their utilization in the industry. Microstructural analyses have been conducted, providing detailed insights into the structure of individual components alongside examinations of the mechanical properties and tool life. These analyses offer a deeper understanding of the efficiency and reliability of the created tools, which is a key element for successful development in the field of cutting and forming tools. The production of functional surfaces and edges using DED technology can result in financial savings, as the entire tool doesn't have to be manufactured from expensive special alloys. The tool can be made from common steel, onto which a functional surface from special materials can be applied. Additionally, it allows for tool repairs after wear and tear, eliminating the need for producing a new part and contributing to an overall cost while reducing the environmental footprint. Overall, the combination of DED technology, functionally graded materials, and verified technologies collectively set a new standard for innovative and efficient development of cutting and forming tools in the modern industrial environment.

Keywords: additive manufacturing, directed energy deposition, DED, laser, cutting tools, forming tools, steel, nickel alloy

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Authors: Parastoo Kazemiyan

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Over the past 80 years, in compliance with the advent of modernity in Iran and Turkey, the presence of women in economic and social arenas has creates serious challenges in the capacity of urban spaces to respond to their presence and transport because urban spaces up until then were based on masculine criteria and therefore, women could use such spaces in the company of their fathers or husbands. However, as modernity expanded by Reza Shah and Ataturk, women found the opportunity to work and be present in urban spaces alongside men and their presence in economic and social domains resulted in their presence in these spaces in the early and late hours of the day. Therefore, the city had to be transformed in structural, social, and environmental terms to accommodate women's activities and presence in various urban arenas, which was a huge step in transition from a masculine man-based culture to an all-inclusive human-based culture in these two countries. However, the optimization of urban space was subject to political changes in the two countries, leading to significant differences in designing urban spaces in Tehran and Istanbul. What shows the importance and novelty of the present study lie in the differences in urban planning and optimization in the two capital cities, which gave rise to different outcomes in desirability and quality of living in these two capital cities. Due to the importance of the topic, one of the most significant factors in desirability and acceptability of urban space for women was examined using a descriptive-analytic method based on qualitative methodology in Tehran and Istanbul. The results showed that the infrastructural factors in Istanbul, including safety of access, variety, and number of public transport modes, transparency, and supervision over public spaces have provided women with a safer and more constant presence compared to Tehran. It seems that challenges involved in providing access to urban spaces in Tehran in terms of infrastructure and function have made Tehran unable to respond to the most basic needs of its female citizens.

Keywords: gender differences, urban space security, access to transportation systems, women's challenges

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Authors: Roengchai Tansuchat, Woraphon Yamaka, Paravee Maneejuk

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From the past recent, the global financial crisis, economic instability, and large fluctuation in agricultural commodity price have led to increased concerns about the volatility transmission among them. The problem is further exacerbated by commodities volatility caused by other commodity price fluctuations, hence the decision on hedging strategy has become both costly and useless. Thus, this paper is conducted to analysis the volatility spillover effect among major agriculture including corn, soybeans, wheat and rice, to help the commodity suppliers hedge their portfolios, and manage the risk and co-volatility of them. We provide a switching regime approach to analyzing the issue of volatility spillovers in different economic conditions, namely upturn and downturn economic. In particular, we investigate relationships and volatility transmissions between these commodities in different economic conditions. We purposed a Copula-based multivariate Markov Switching GARCH model with two regimes that depend on an economic conditions and perform simulation study to check the accuracy of our proposed model. In this study, the correlation term in the cross-hedge ratio is obtained from six copula families – two elliptical copulas (Gaussian and Student-t) and four Archimedean copulas (Clayton, Gumbel, Frank, and Joe). We use one-step maximum likelihood estimation techniques to estimate our models and compare the performance of these copula using Akaike information criterion (AIC) and Bayesian information criteria (BIC). In the application study of agriculture commodities, the weekly data used are conducted from 4 January 2005 to 1 September 2016, covering 612 observations. The empirical results indicate that the volatility spillover effects among cereal futures are different, as response of different economic condition. In addition, the results of hedge effectiveness will also suggest the optimal cross hedge strategies in different economic condition especially upturn and downturn economic.

Keywords: agricultural commodity futures, cereal, cross-hedge, spillover effect, switching regime approach

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Authors: Amir Nazemi, Milad Ramezankhani, Marian Kӧrber, Abbas S. Milani

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The excellent strength to weight ratio of woven fabric composites, along with their high formability, is one of the primary design parameters defining their increased use in modern manufacturing processes, including those in aerospace and automotive. However, for emerging automated preform processes under the smart manufacturing paradigm, complex geometries of finished components continue to bring several challenges to the designers to cope with manufacturing defects on site. Wrinklinge. g. is a common defectoccurring during the forming process and handling of semi-finished textile composites. One of the main reasons for this defect is the weak bending stiffness of fibers in unconsolidated state, causing excessive relative motion between them. Further challenges are represented by the automated handling of large-area fiber blanks with specialized gripper systems. For fabric composites forming simulations, the finite element (FE)method is a longstanding tool usedfor prediction and mitigation of manufacturing defects. Such simulations are predominately meant, not only to predict the onset, growth, and shape of wrinkles but also to determine the best processing condition that can yield optimized positioning of the fibers upon forming (or robot handling in the automated processes case). However, the need for use of small-time steps via explicit FE codes, facing numerical instabilities, as well as large computational time, are among notable drawbacks of the current FEtools, hindering their extensive use as fast and yet efficient digital twins in industry. This paper presents a novel woven fabric simulation technique through the application of the material point method (MPM), which enables the use of much larger time steps, facing less numerical instabilities, hence the ability to run significantly faster and efficient simulationsfor fabric materials handling and forming processes. Therefore, this method has the ability to enhance the development of automated fiber handling and preform processes by calculating the physical interactions with the MPM fiber models and rigid tool components. This enables the designers to virtually develop, test, and optimize their processes based on either algorithmicor Machine Learning applications. As a preliminary case study, forming of a hemispherical plain weave is shown, and the results are compared to theFE simulations, as well as experiments.

Keywords: material point method, woven fabric composites, forming, material handling

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Authors: Silvia Alaimo

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This lecture brings to our attention the theme of spirituality within Gestalt therapy’s theoretical and clinical perspectives and which is closely connected to the fertile emptiness and creative indifference’ experiences. First of all, the premise that must be done is the overcoming traditional western culture’s philosophical and religious misunderstandings, such as the dicotomy between spirituality and pratical/material daily life, as well as the widespread secular perspective of classic psychology. Even fullness and emptiness have traditionally been associated with the concepts of being and not being. "There is only one way through which we can contact the deepest layers of our existence, rejuvenate our thinking and reach intuition (the harmony of thought and being): inner silence" (Perls) *. Therefore, "fertile void" doesn't mean empty in itself, but rather an useful condition of every creative and responsible act, making room for a deeper dimension close to spirituality. Spirituality concerns questions about the meaning of existence, which lays beyond the concrete and literal dimension, looking for the essence of things, and looking at the value of personal experience. Looking at fundamentals of Gestalt epistemology, phenomenology, aesthetics, and the relationship, we can reach the heart of a therapeutic work that takes spiritual contours and which are based on an embodied (incarnate size), through the relational aesthetic knowledge (Spagnuolo Lobb ), the deep contact with each other, the role of compassion and responsibility, as the patient's recognition criteria (Orange, 2013) rooted in the body. The aesthetic dimension, like the spiritual dimension to which it is often associated, is a subtle dimension: it is the dimension of the essence of things, of their "soul." In clinical practice, it implies that the relationship between therapist and patient is "in the absence of judgment," also called "zero point of creative indifference," expressed by ‘therapeutic mentality’. It consists in following with interest and authentic curiosity where the patient wants to go and support him in his intentionality of contact. It’s a condition of pure and simple awareness, of the full acceptance of "what is," a moment of detachment from one's own life in which one does not take oneself too seriously, a starting point for finding a center of balance and integration that brings to the creative act, to growth, and, as Perls would say, to the excitement and adventure of living.

Keywords: spirituality, bodily, embodied aesthetics, phenomenology, relationship

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Authors: Mohd Asharf Ganie, Aafia Rashid, Mohd Afzal Zargar, Showkat Ali Zargar, Syed Mudasar, Tabasum Parvaiz, Zafar Amin Shah

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Accumulating evidence suggests that Vitamin D deficiency (VDD) might at least contribute to the metabolic co-morbidities in PCOS. Hence, we aimed to study the effect of vitamin D supplementation in co-prescription with insulin sensitizers like metformin and pioglitazone on clinical, hormonal and metabolic parameters in women with PCOS. In this open label randomized, controlled trial a total of 120 women with PCOS diagnosis (AE-PCOS 2009 Criteria) were assigned to four treatment groups (n= 30 in each): group I (metformin 1 gm/day in combination with cholecalciferol 4000 IU/day), group II (pioglitazone 30 mg/day in combination with cholecalciferol 4000 IU/day), group III (metformin 1 gm /day) and group IV (pioglitazone 30 mg/day). Vitamin D supplementation was given as 60,000 units every two weeks for 24 weeks. All the subjects were routinely evaluated for clinical, biochemical, hormonal and insulin sensitivity parameters in addition to various safety parameters especially serum calcium levels at baseline and after 24 weeks of the treatment. Our results indicate that 95.5% of PCOS women were vitamin D deficient at baseline. Serum 25 (OH) D levels increased significantly (p < 0.001) in groups I and II without any adverse effects after 24 weeks of oral administration of 4000 IU cholecalciferol daily. However, serum 25 (OH) D levels remained unchanged in group III and IV. By six months, number of menstrual cycles per year increased whereas Ferriman-Gallwey score, serum total testosterone and HOMA-IR decreased significantly (P < 0.001) in the treatment groups supplemented with cholecalciferol as compared to those treated either drug alone. No significant beneficial changes were observed on weight, BMI, blood pressure, glucose tolerance and serum lipids in any of the groups supplemented with cholecalciferol. We conclude that daily dose of 4000 IU cholecalciferol might be a useful adjunct in complex treatment of PCOS with fewer adverse events. Furthermore, pioglitazone and cholecalciferol combination seems to be marginally better although there was no statistical significance.

Keywords: PCOS, vitamin D supplementation, insulin resistance, spironolactone, metformin, pioglitazone

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Authors: Afshan Channa, Sameeha Aleem, Harim Mohsin

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First rank symptoms (FRS) are considered to be pathognomic for Schizophrenia. However, FRS is not a distinctive feature of Schizophrenia. It has also been noticed in affective disorder, albeit not inclusive in diagnostic criteria. The presence of FRS in Mania leads to misdiagnosis of psychotic illness, further complicating the management and delay of appropriate treatment. FRS in Mania is associated with poor clinical and functional outcome. Its existence in the first episode of bipolar disorder may be a predictor of poor short-term outcome and decompensating course of illness. FRS in Mania is studied in west. However, the cultural divergence and detriments make it pertinent to study the frequency of FRS in affective disorder independently in Pakistan. Objective: The frequency of first rank symptoms in manic patients, who were under treatment at psychiatric services of tertiary care hospital. Method: The cross sectional study was done at psychiatric services of Aga Khan University Hospital, Karachi, Pakistan. One hundred and twenty manic patients were recruited from November 2014 to May 2015. The patients who were unable to comprehend Urdu or had comorbid psychiatric or organic disorder were excluded. FRS was assessed by administration of validated Urdu version of Present State Examination (PSE) tool. Result: The mean age of the patients was 37.62 + 12.51. The mean number of previous manic episode was 2.17 + 2.23. 11.2% males and 30.6% females had FRS. This association of first rank symptoms with gender in patients of mania was found to be significant with a p-value of 0.008. All-inclusive, 19.2% exhibited FRS in their course of illness. 43.5% had thought broadcasting, made feeling, impulses, action and somatic passivity. 39.1% had thought insertion, 30.4% had auditory perceptual distortion, and 17.4% had thought withdrawal. However, none displayed delusional perception. Conclusion: The study confirms the presence of FRS in mania in both male and female, irrespective of the duration of current manic illness or previous number of manic episodes. A substantial difference was established between both the genders. Being married had no protective effect on the presence of FRS.

Keywords: first rank symptoms, Mania, psychosis, present state examination

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Authors: Chalachew Gashu, Yoseph Kassa, Habtamu Geremew, Mengestie Mulugeta

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Background and Aims: Severe acute malnutrition remains a significant health challenge, particularly in low‐ and middle‐income countries. The aim of this study was to determine the survival time of under‐five children with severe acute malnutrition. Methods: A retrospective cohort study was conducted at a hospital, focusing on under‐five children with severe acute malnutrition. The study included 322 inpatients admitted to the Chiro hospital in Chiro, Ethiopia, between September 2019 and August 2020, whose data was obtained from medical records. Survival functions were analyzed using Kaplan‒Meier plots and log‐rank tests. The survival time of severe acute malnutrition was further analyzed using the Cox proportional hazards model and Bayesian parametric survival models, employing integrated nested Laplace approximation methods. Results: Among the 322 patients, 118 (36.6%) died as a result of severe acute malnutrition. The estimated median survival time for inpatients was found to be 2 weeks. Model selection criteria favored the Bayesian Weibull accelerated failure time model, which demonstrated that age, body temperature, pulse rate, nasogastric (NG) tube usage, hypoglycemia, anemia, diarrhea, dehydration, malaria, and pneumonia significantly influenced the survival time of severe acute malnutrition. Conclusions: This study revealed that children below 24 months, those with altered body temperature and pulse rate, NG tube usage, hypoglycemia, and comorbidities such as anemia, diarrhea, dehydration, malaria, and pneumonia had a shorter survival time when affected by severe acute malnutrition under the age of five. To reduce the death rate of children under 5 years of age, it is necessary to design community management for acute malnutrition to ensure early detection and improve access to and coverage for children who are malnourished.

Keywords: Bayesian analysis, severe acute malnutrition, survival data analysis, survival time

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Authors: Theophilus O. Odunlami, Hasan Haroglu, Nader Saleh-Matter

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The challenges facing the construction industry are often worsened by the compounded nature of projects coupled with the complexity of key stakeholders involved at different stages of the project. Projects are planned to achieve outlined benefits in line with the business case; however, a lack of effective management of key stakeholders can result in unrealistic delivery aspirations, unnecessary re-works, and overruns. The aim of this study is to examine the early stages of a project lifecycle and investigate the stakeholder management and involvement processes and their impact on the successful delivery of the project. The research engaged with conventional construction organisations and project personnel and stakeholders on diverse projects, using a research strategy to analyse existing project case studies, narrative enquiries, interviews, and surveys using a combined qualitative, quantitative, and mixed method of analysis. Research findings have shown that the involvement of stakeholders at different levels during the early stages has pronounced effects on project delivery; it helps to forge synergy and promotes a clear understanding of individual responsibilities, strengths, and weaknesses. This has often fostered a positive sense of productive collaboration right through the early stages of the project. These research findings intend to contribute to the development of a process framework for stakeholder and project team involvement in the early stages of a project. This framework will align with the selection criteria for stakeholders, contractors, and resources, ultimately contributing to the successful completion of projects. The primary question addressed in this study is stakeholder involvement and management of the early stages of a building project life cycle impacts project delivery. Findings showed that early-stage stakeholder involvement and collaboration between project teams and contractors significantly contribute to project success. However, a strong and healthy communication strategy would be required to maintain the flow of value-added ideas among stakeholders at the early stages to benefit the project at the execution stage.

Keywords: early stages, project lifecycle, stakeholders, decision-making strategy, project framework

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