Search results for: acquired ability to enact lethal self-injury
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 5358

Search results for: acquired ability to enact lethal self-injury

1908 Investigation of the Functional Impact of Amblyopia on Visual Skills in Children

Authors: Chinmay V. Deshpande

Abstract:

Purpose: To assess the efficiency of visual functions and visual skills in strabismic & anisometropic amblyopes and to assess visual acuity and contrast sensitivity in anisometropic amblyopes with spectacles & contact lenses. Method: In a prospective clinical study, 32 children ageing from 5 to 15 years presenting with amblyopia in a pediatric department of Shri Ganapati Netralaya Jalna, India, were assessed for a period of three & half months. Visual acuity was measured with Snellen’s and Bailey-Lovie log MAR charts whereas contrast sensitivity was measured with Pelli-Robson chart with spectacles and contact lenses. Saccadic movements were assessed with SCCO scoring criteria and accommodative facility was checked with ±1.50 DS flippers. Stereopsis was assessed with TNO test. Results: By using Wilcoxon sign rank test p-value < 0.05 (< 0.001), the mean linear visual acuity was 0.29 (≈ 6/21) and mean single optotype visual acuity found to be 0.36 (≈ 6/18). Mean visual acuity of 0.27(≈ 6/21) with spectacles improved to 0.33 (≈ 6/18) with contact lenses in amblyopic eyes. The mean Log MAR visual acuity with spectacles and contact lens were found to be 0.602( ≈6/24) and 0.531(≈ 6/21) respectively. The contrast threshold out of 20 amblyopic eyes shows that mean contrast threshold changed in 9 patients from spectacles 0.27 to contact lens 0.19 respectively. The mean accommodative facility assessed was 5.31(± 2.37). 24 subjects (75%) revealed marked saccadic defects on the test applied. 78% subjects didn’t show even gross stereoscopic ability on TNO test. Conclusion: This study supports the facts about amblyopia and associated deficits in visual skills which are claimed in previous studies. In addition, anisometropic amblyopia can be managed better with contact lenses.

Keywords: strabismus, anisometropia, amblyopia, contrast sensitivity, saccades, stereopsis

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1907 European Union Health Policy and the Response to COVID-19 Pandemic: Building a European Health Union

Authors: Aikaterini Tsalampouni

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The European Union has long been the most developed model of economic and political integration that has brought a common market, a common currency and a standardization of national policies in certain areas in consistent with EU values and principles. To this direction, there is a parallel process of social integration that effect public policy decisions of member states. Even though social policy, i.e. social protection and moreover healthcare policy, still remains in state's responsibility to develop, EU applies different mechanisms in order to influence health policy systems, since from a more federalist point of view, EU ought to expand its regulatory and legislative roles in as many policy areas as possible. Recently, the pandemic has become a turning point for health care provision and at the same time has also highlighted the need to strengthen the EU’s role in coordinating health care. This paper analyses the EU health policy in general, as well as the response to COVID-19 pandemic with an attempt to identify indications of interaction between EU policies and the promotion of sustainable and resilient health systems. More analytically, the paper investigates the EU binding legal instruments, non-binding legal instruments, monitoring and assessment instruments and instruments for co-financing concerning health care provision in member states and records the evolution of health policies before and during the COVID-19 pandemic. The paper concludes by articulating some remarks regarding the improvement of health policy in EU. Since the ability to deal with a pandemic depends on continuous and increased investment in health systems, the involvement of the EU can lead to a policy convergence, necessary for the resilience of the systems, maintaining at the same time, a strong health policy framework in Europe.

Keywords: EU health policy, EU response to COVID-19, European Health Union, health systems in Europe

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1906 Not Three Gods but One: Why Reductionism Does Not Serve Our Theological Discourse

Authors: Finley Lawson

Abstract:

The triune nature of God is one of the most complex doctrines of Christianity, and its complexity is further compounded when one considers the incarnation. However, many of the difficulties and paradoxes associated with our idea of the divine arise from our adherence to reductionist ontology. In order to move our theological discourse forward, in respect to divine and human nature, a holistic interpretation of our profession of faith is necessary. The challenge of a holistic interpretation is that it questions our ability to make any statement about the genuine, ontological individuation of persons (both divine and human), and in doing so raises the issue of whether we are, ontologically, bound to descend in to a form of pan(en)theism. In order to address the ‘inevitable’ slide in to pan(en)theism. The impact of two forms of holistic interpretation, Boolean and Non-Boolean, on our concept of personhood will be examined. Whilst a Boolean interpretation allows for a greater understanding of the relational nature of the Trinity, it is the Non-Boolean interpretation which has greater ontological significance. A Non-Boolean ontology, grounded in our scientific understanding of the nature of the world, shows our quest for individuation rests not in ontological fact but in epistemic need, and that it is our limited epistemology that drives our need to divide that which is ontologically indivisible. This discussion takes place within a ‘methodological’, rather than ‘doctrinal’ approach to science and religion - examining assumptions and methods that have shaped our language and beliefs about key doctrines, rather than seeking to reconcile particular Christian doctrines with particular scientific theories. Concluding that Non-Boolean holism is the more significant for our doctrine is, in itself, not enough. A world without division appears much removed from the distinct place of man and divine as espoused in our creedal affirmation, to this end, several possible interpretations for understanding Non-Boolean human – divine relations are tentatively put forward for consideration.

Keywords: holism, individuation, ontology, Trinitarian relations

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1905 Providing a Proposed Framework for the Copyright of Library Resources in Iran: A Comparative Study of the Copyright Laws of Iran, Australia and U.S.

Authors: Zeinab Papi

Abstract:

This study was aimed at analyzing the copyright laws of Iran, Australia, the U.S., and library portals, thereby providing a proposed framework for the copyright of library resources for the NLAI and other Iranian libraries while considering the current situation and the internal Iranian laws. This is an applied study falling in the category of qualitative approach research. Documentary analysis method and comparative method were used to resolve the problem and answer the questions of the research. The two National Library of Australia (NLA) and Library of Congress (LC), together with the NLAI formed the research community. In addition, the Iranian Law for the Protection of Authors, Composers and Artists Rights (1970); the Australian Copyright Act (1968), and the U.S. Copyright Law (1976) were purposefully selected as three main resources among other documents and resources. Findings revealed that the dimensions of fair and non-profit use, duration of copyright, license, and agreement, copyright policy, moral rights, economic rights, and infringement of copyright were the main dimensions that, along with 49 main components, formed the proposed framework for the copyright of information resources for the NLAI and other Iranian libraries. It should be acknowledged that there are some differences in different copyright fields between countries' laws, and each country takes into account its internal conditions to compile and revise the laws. By following the laws of other countries, it is possible to effectively improve and develop copyright laws. The researcher hopes that this research can have its effects in creating awareness and ability among librarians, formulating a copyright policy in Iranian libraries, and helping legislators in revising copyright laws regarding library exceptions and exemptions.

Keywords: copyright, library resources, National Library and Archives of the I.R. of Iran, National Library of Australia, Library of Congress, copyright law

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1904 A Fact-Finding Analysis on the Expulsions Made under Title 42 in Us

Authors: Avi Shrivastava

Abstract:

Title 42, an emergency health decree, has forced the federal authorities to turn away asylum seekers and all other border crossers since last year. When Title 42 was first deployed in immigration detention centers, where many migrants are held when they arrive at the U.S.-Mexico border, the Trump administration embraced it as a strategy. Expulsions Policy and New Border Challenges will be examined in regard to Title 42 concerns. Humanitarian measures for refugees arriving at the US-Mexico border are the focus of this article. To a large extent, this article addresses the implications of the United States' use of Title 42 in expelling refugees and the possible ramifications of doing away with it. A secondary data collecting strategy was used to gather the information for this study, allowing researchers to examine a large number of previously collected data sets. Information about Title 42 may be found in a variety of places, such as scholarly publications, newspapers, books, and the internet. The inquiry employed qualitative and explanatory research approaches. The claim that 1.7 million individuals were forced to leave the country as a result of it was withdrawn. Since CBP and ICE were limited in their ability to process deportees, it employed a very random patchwork technique in selecting the expelled individuals. As a consequence, repeat offenders, particularly those who were single, got a reduced punishment. The government will be compelled to focus on long-overdue but vital border enhancements if expulsions are halted. Title 42 provisions may help expedite the processing of asylum and other types of humanitarian relief. The government is prepared for an increase in arrivals, but ending the program would lead to a return to arrival levels seen during the Title 42 period.

Keywords: migrants, refugees, title 42, medical, trump administration

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1903 The Relationship Between Soldiers’ Psychological Resilience, Leadership Style and Organisational Commitment

Authors: Rosita Kanapeckaite

Abstract:

The modern operational military environment is a combination of factors such as change, uncertainty, complexity and ambiguity. Stiehm (2002) refers to such situations as VUCA situations. VUCA is an acronym commonly used to describe the volatility, uncertainty, complexity and ambiguity of various situations and conditions. Increasingly fast-paced military operations require military personnel to demonstrate readiness and resilience under stressful conditions in order to maintain the optimum cognitive and physical performance necessary to achieve success. Military resilience can be defined as the ability to cope with the negative effects of setbacks and associated stress on military performance and combat effectiveness. In the volatile, uncertain, complex and ambiguous modern operational environment, both current and future operations require and place a higher priority on enhancing and maintaining troop readiness and resilience to win decisively in multidimensional combat. This paper explores the phenomenon of soldiers' psychological resilience, theories of leadership, and commitment to the organisation. The aim of the study is to examine the relationship between soldiers' psychological resilience, leadership style and commitment to the organisation. The study involved 425 professional soldiers, the research method was a questionnaire survey. The instruments used were measures of psychological resilience, leadership styles and commitment to the organisation. Results: transformational leadership style predicts higher psychological resilience, and psychologically resilient professional servicemen are more committed to the organisation. The study confirms the importance of soldiers' psychological resilience for their commitment to the organisation. The paper also discusses practical applications.

Keywords: resilience, commitment, solders, leadership style

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1902 A Stochastic Diffusion Process Based on the Two-Parameters Weibull Density Function

Authors: Meriem Bahij, Ahmed Nafidi, Boujemâa Achchab, Sílvio M. A. Gama, José A. O. Matos

Abstract:

Stochastic modeling concerns the use of probability to model real-world situations in which uncertainty is present. Therefore, the purpose of stochastic modeling is to estimate the probability of outcomes within a forecast, i.e. to be able to predict what conditions or decisions might happen under different situations. In the present study, we present a model of a stochastic diffusion process based on the bi-Weibull distribution function (its trend is proportional to the bi-Weibull probability density function). In general, the Weibull distribution has the ability to assume the characteristics of many different types of distributions. This has made it very popular among engineers and quality practitioners, who have considered it the most commonly used distribution for studying problems such as modeling reliability data, accelerated life testing, and maintainability modeling and analysis. In this work, we start by obtaining the probabilistic characteristics of this model, as the explicit expression of the process, its trends, and its distribution by transforming the diffusion process in a Wiener process as shown in the Ricciaardi theorem. Then, we develop the statistical inference of this model using the maximum likelihood methodology. Finally, we analyse with simulated data the computational problems associated with the parameters, an issue of great importance in its application to real data with the use of the convergence analysis methods. Overall, the use of a stochastic model reflects only a pragmatic decision on the part of the modeler. According to the data that is available and the universe of models known to the modeler, this model represents the best currently available description of the phenomenon under consideration.

Keywords: diffusion process, discrete sampling, likelihood estimation method, simulation, stochastic diffusion process, trends functions, bi-parameters weibull density function

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1901 Design and Evaluation of Corrective Orthosis Knee for Hyperextension

Authors: Valentina Narvaez Gaitan, Paula K. Rodriguez Ramirez, Derian D. Espinosa

Abstract:

Corrective orthosis has great importance in orthopedic treatments providing assistance in improving mobility and stability in order to improve the quality of life for a different patient. The corrective orthosis studied in this article can correct deformities, reduce pain, and improve the ability to perform daily activities. This work describes the design and evaluation of a corrective orthosis for knee hyperextension. This orthosis is capable of generating a progressive and variable alignment of the joint, limiting the range of motion according to medical criteria. The main objective was to design a corrective knee orthosis capable of correcting knee hyperextension progressively to return to its natural angle with greater economic affordability and adjustable size. The limiting mechanism is based on a goniometer to determine the desired angles. The orthosis was made of acrylic to reduce costs and maintenance; neoprene is also used to make comfortable contact; additionally, Velcro was used in order to adjust the orthosis for various sizes. Simulations of static and fatigue analysis of the mechanism were performed to verify its resistance and durability under normal conditions. A biomechanical gait study of gait was carried out on 10 healthy subjects without the orthosis and limiting their knee extension capacity in a normal gait cycle with the orthosis to observe the efficiency of the proposed system. In the results obtained, the knee angle curves show that the maximum extension angle was the established angle by the orthosis. Showing the efficiency of the proposed design for different leg sizes.

Keywords: biomechanical study, corrective orthosis, efficiency, goniometer, knee hyperextension.

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1900 Financing the Welfare State in the United States: The Recent American Economic and Ideological Challenges

Authors: Rafat Fazeli, Reza Fazeli

Abstract:

This paper focuses on the study of the welfare state and social wage in the leading liberal economy of the United States. The welfare state acquired a broad acceptance as a major socioeconomic achievement of the liberal democracy in the Western industrialized countries during the postwar boom period. The modern and modified vision of capitalist democracy offered, on the one hand, the possibility of high growth rate and, on the other hand, the possibility of continued progression of a comprehensive system of social support for a wider population. The economic crises of the 1970s, provided the ground for a great shift in economic policy and ideology in several Western countries, most notably the United States and the United Kingdom (and to a lesser extent Canada under Prime Minister Brian Mulroney). In the 1980s, the free market oriented reforms undertaken under Reagan and Thatcher greatly affected the economic outlook not only of the United States and the United Kingdom, but of the whole Western world. The movement which was behind this shift in policy is often called neo-conservatism. The neoconservatives blamed the transfer programs for the decline in economic performance during the 1970s and argued that cuts in spending were required to go back to the golden age of full employment. The agenda for both Reagan and Thatcher administrations was rolling back the welfare state, and their budgets included a wide range of cuts for social programs. The question is how successful were Reagan and Thatcher’s efforts to achieve retrenchment? The paper involves an empirical study concerning the distributive role of the welfare state in the two countries. Other studies have often concentrated on the redistributive effect of fiscal policy on different income brackets. This study examines the net benefit/ burden position of the working population with respect to state expenditures and taxes in the postwar period. This measurement will enable us to find out whether the working population has received a net gain (or net social wage). This study will discuss how the expansion of social expenditures and the trend of the ‘net social wage’ can be linked to distinct forms of economic and social organizations. This study provides an empirical foundation for analyzing the growing significance of ‘social wage’ or the collectivization of consumption and the share of social or collective consumption in total consumption of the working population in the recent decades. The paper addresses three other major questions. The first question is whether the expansion of social expenditures has posed any drag on capital accumulation and economic growth. The findings of this study provide an analytical foundation to evaluate the neoconservative claim that the welfare state is itself the source of economic stagnation that leads to the crisis of the welfare state. The second question is whether the increasing ideological challenges from the right and the competitive pressures of globalization have led to retrenchment of the American welfare states in the recent decades. The third question is how social policies have performed in the presence of the rising inequalities in the recent decades.

Keywords: the welfare state, social wage, The United States, limits to growth

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1899 Socio-Motor Experience between Affectivity and Movement from Harry Potter to Lord of the Rings

Authors: Manuela Gamba, Niki Mandolesi

Abstract:

Teenagers today have little knowledge about how to move or play together. The adults who are part of sports culture must find an effective way to foster this essential ability. Our research in Italy uses a 'holistic model' based on fantasy literature to explore the relationships between the game identities and self-identities of young people and the achievement of psycho-motor, emotional and social well-being in the realms of sport and education. Physical activity projects were carried out in schools and extra-curricular associations in Rome, combining outdoor activities and distance learning. This holistic and malleable game model is inspired by fantasy accounts of the journeys taken in The Lord of Rings and Harry Potter books. We know that many have a lot of resistance to the idea of using fantasy and play as a pedagogical tool, but the results obtained in this experience are surprising. Our interventions and investigations focused on promoting self-esteem, awareness, a sense of belonging, social integration, cooperation, well-being, and informed decision making: a basis for healthy and effective citizenship. For teenagers, creative thinking is the right stimulus to involve and compare the story of characters to their own journey through social and self-reflective identity analysis. We observed how important it is to engage students emotionally as well as cognitively and that enabling them to play with identity through relationships with peers. There is a need today for a multidisciplinary synthesis of analog and digital values, especially in response to recent distance-living experiences. There is a need for a global reconceptualization of free time and nature in the human experience.

Keywords: awareness, creativity, identity, play

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1898 Ultrasound-Assisted Extraction of Carotenoids from Tangerine Peel Using Ostrich Oil as a Green Solvent and Optimization of the Process by Response Surface Methodology

Authors: Fariba Tadayon, Nika Gharahgolooyan, Ateke Tadayon, Mostafa Jafarian

Abstract:

Carotenoid pigments are a various group of lipophilic compounds that generate the yellow to red colors of many plants, foods and flowers. A well-known type of carotenoids which is pro-vitamin A is β-carotene. Due to the color of citrus fruit’s peel, the peel can be a good source of different carotenoids. Ostrich oil is one of the most valuable foundations in many branches of industry, medicine, cosmetics and nutrition. The animal-based ostrich oil could be considered as an alternative and green solvent. Following this study, wastes of citrus peel will recycle by a simple method and extracted carotenoids can increase properties of ostrich oil. In this work, a simple and efficient method for extraction of carotenoids from tangerine peel was designed. Ultrasound-assisted extraction (UAE) showed significant effect on the extraction rate by increasing the mass transfer rate. Ostrich oil can be used as a green solvent in many studies to eliminate petroleum-based solvents. Since tangerine peel is a complex source of different carotenoids separation and determination was performed by high-performance liquid chromatography (HPLC). In addition, the ability of ostrich oil and sunflower oil in carotenoid extraction from tangerine peel and carrot was compared. The highest yield of β-carotene extracted from tangerine peel using sunflower oil and ostrich oil were 75.741 and 88.110 (mg/L), respectively. Optimization of the process was achieved by response surface methodology (RSM) and the optimal extraction conditions were tangerine peel powder particle size of 0.180 mm, ultrasonic intensity of 19 W/cm2 and sonication time of 30 minutes.

Keywords: β-carotene, carotenoids, citrus peel, ostrich oil, response surface methodology, ultrasound-assisted extraction

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1897 Spatio-Temporal Changes of Rainfall in São Paulo, Brazil (1973-2012): A Gamma Distribution and Cluster Analysis

Authors: Guilherme Henrique Gabriel, Lucí Hidalgo Nunes

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An important feature of rainfall regimes is the variability, which is subject to the atmosphere’s general and regional dynamics, geographical position and relief. Despite being inherent to the climate system, it can harshly impact virtually all human activities. In turn, global climate change has the ability to significantly affect smaller-scale rainfall regimes by altering their current variability patterns. In this regard, it is useful to know if regional climates are changing over time and whether it is possible to link these variations to climate change trends observed globally. This study is part of an international project (Metropole-FAPESP, Proc. 2012/51876-0 and Proc. 2015/11035-5) and the objective was to identify and evaluate possible changes in rainfall behavior in the state of São Paulo, southeastern Brazil, using rainfall data from 79 rain gauges for the last forty years. Cluster analysis and gamma distribution parameters were used for evaluating spatial and temporal trends, and the outcomes are presented by means of geographic information systems tools. Results show remarkable changes in rainfall distribution patterns in São Paulo over the years: changes in shape and scale parameters of gamma distribution indicate both an increase in the irregularity of rainfall distribution and the probability of occurrence of extreme events. Additionally, the spatial outcome of cluster analysis along with the gamma distribution parameters suggest that changes occurred simultaneously over the whole area, indicating that they could be related to remote causes beyond the local and regional ones, especially in a current global climate change scenario.

Keywords: climate change, cluster analysis, gamma distribution, rainfall

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1896 Heating of the Ions by Electromagnetic Ion Cyclotron (EMIC) Waves Using Magnetospheric Multiscale (MMS) Satellite Observation

Authors: A. A. Abid

Abstract:

The magnetospheric multiscale (MMS) satellite observations in the inner magnetosphere were used to detect the proton band of the electromagnetic ion cyclotron (EMIC) waves on December 14, 2015, which have been significantly contributing to the dynamics of the magnetosphere. It has been examined that the intensity of EMIC waves gradually increases by decreasing the L shell. The waves are triggered by hot proton thermal anisotropy. The low-energy cold protons (ions) can be activated by the EMIC waves when the EMIC wave intensity is high. As a result, these previously invisible protons are now visible. As a result, the EMC waves also excite the helium ions. The EMIC waves, whose frequency in the magnetosphere of the Earth ranges from 0.001 Hz to 5 Hz, have drawn a lot of attention for their ability to carry energy. Since these waves act as a mechanism for the loss of energetic electrons from the Van Allen radiation belt to the atmosphere, therefore, it is necessary to understand how and where they can be produced, as well as the direction of waves along the magnetic field lines. This work examines how the excitation of EMIC waves is affected by the energy of hot proton temperature anisotropy, and It has a minimum resonance energy of 6.9 keV and a range of 7 to 26 keV. On the hot protons, however, the reverse effect can be seen for energies below the minimum resonance energy. It is demonstrated that throughout the energy range of 1 eV to 100 eV, the number density and temperature anisotropy of the protons likewise rise as the intensity of the EMIC waves increases. Key Points: 1. The analysis of EMIC waves produced by hot proton temperature anisotropy using MMS data. 2. The number density and temperature anisotropy of the cold protons increases owing to high-intensity EMIC waves. 3. The cold protons with an energy range of 1-100eV are energized by EMIC waves using the Magnetospheric Multiscale (MMS) satellite not been discussed before

Keywords: EMIC waves, temperature anisotropy of hot protons, energization of the cold proton, magnetospheric multiscale (MMS) satellite observations

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1895 Comparing Radiographic Detection of Simulated Syndesmosis Instability Using Standard 2D Fluoroscopy Versus 3D Cone-Beam Computed Tomography

Authors: Diane Ghanem, Arjun Gupta, Rohan Vijayan, Ali Uneri, Babar Shafiq

Abstract:

Introduction: Ankle sprains and fractures often result in syndesmosis injuries. Unstable syndesmotic injuries result from relative motion between the distal ends of the tibia and fibula, anatomic juncture which should otherwise be rigid, and warrant operative management. Clinical and radiological evaluations of intraoperative syndesmosis stability remain a challenging task as traditional 2D fluoroscopy is limited to a uniplanar translational displacement. The purpose of this pilot cadaveric study is to compare the 2D fluoroscopy and 3D cone beam computed tomography (CBCT) stress-induced syndesmosis displacements. Methods: Three fresh-frozen lower legs underwent 2D fluoroscopy and 3D CIOS CBCT to measure syndesmosis position before dissection. Syndesmotic injury was simulated by resecting the (1) anterior inferior tibiofibular ligament (AITFL), the (2) posterior inferior tibiofibular ligament (PITFL) and the inferior transverse ligament (ITL) simultaneously, followed by the (3) interosseous membrane (IOM). Manual external rotation and Cotton stress test were performed after each of the three resections and 2D and 3D images were acquired. Relevant 2D and 3D parameters included the tibiofibular overlap (TFO), tibiofibular clear space (TCS), relative rotation of the fibula, and anterior-posterior (AP) and medial-lateral (ML) translations of the fibula relative to the tibia. Parameters were measured by two independent observers. Inter-rater reliability was assessed by intraclass correlation coefficient (ICC) to determine measurement precision. Results: Significant mismatches were found in the trends between the 2D and 3D measurements when assessing for TFO, TCS and AP translation across the different resection states. Using 3D CBCT, TFO was inversely proportional to the number of resected ligaments while TCS was directly proportional to the latter across all cadavers and ‘resection + stress’ states. Using 2D fluoroscopy, this trend was not respected under the Cotton stress test. 3D AP translation did not show a reliable trend whereas 2D AP translation of the fibula was positive under the Cotton stress test and negative under the external rotation. 3D relative rotation of the fibula, assessed using the Tang et al. ratio method and Beisemann et al. angular method, suggested slight overall internal rotation with complete resection of the ligaments, with a change < 2mm - threshold which corresponds to the commonly used buffer to account for physiologic laxity as per clinical judgment of the surgeon. Excellent agreement (>0.90) was found between the two independent observers for each of the parameters in both 2D and 3D (overall ICC 0.9968, 95% CI 0.995 - 0.999). Conclusions: The 3D CIOS CBCT appears to reliably depict the trend in TFO and TCS. This might be due to the additional detection of relevant rotational malpositions of the fibula in comparison to the standard 2D fluoroscopy which is limited to a single plane translation. A better understanding of 3D imaging may help surgeons identify the precise measurements planes needed to achieve better syndesmosis repair.

Keywords: 2D fluoroscopy, 3D computed tomography, image processing, syndesmosis injury

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1894 Isolation and Characterization of Bacteriophages Against Aeromonas Spp. Mediated Diseases in Indian Aquaculture

Authors: Mrunalini Sonne

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Aquaculture uses a variety of broad spectrum antibiotics to manage and prevent a variety of diseases without understanding their mechanisms of action. This has led to water pollution in the modern world. The necessity for alternate control measures against bacterial illnesses in the aquaculture sector is highlighted by issues brought on by antibiotic-resistant bacteria and the dearth of effective control strategies. Bacteriophages (phages) have shown promise as therapeutic agents for the efficient management of bacterial infections in aquaculture. In the current study, a variety of investigations were conducted to determine if utilizing lytic phages to reduce Aeromonas spp. infection in fish aquaculture was appropriate. Motile Aeromonas septicaemia is a fish disease that has caused financial harm to the aquaculture sector. Currently, the production of aquaculture depends significantly on antibiotics, which adds to the worldwide problem of the rise of bacteria that are resistant to medicines and resistance genes. To decrease the usage of antibiotics in aquaculture systems, it is crucial to create efficient antibiotic substitutes. Bacteriophages are capable of acting as a natural antagonist, mostly because of their great specificity, capacity for self-replication, and ability to quickly eradicate dangerous bacteria. There is a need for research that goes beyond just isolating and characterising lytic bacteriophages to examine their morphology, stability, and efficacy in various environmental conditions. Bacteriophage (or phage) therapy is a promising technique to control dangerous microbes in farmed fish. More phage therapy research in aquaculture is required in order to effectively employ phage treatment to lessen infection in fish brought on by Aeromonas.

Keywords: aquaculture, bacteriophages, fish, freshwater

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1893 Shortening Distances: The Link between Logistics and International Trade

Authors: Felipe Bedoya Maya, Agustina Calatayud, Vileydy Gonzalez Mejia

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Encompassing inventory, warehousing, and transportation management, logistics is a crucial predictor of firm performance. This has been extensively proven by extant literature in business and operations management. Logistics is also a fundamental determinant of a country's ability to access international markets. Available studies in international and transport economics have shown that limited transport infrastructure and underperforming transport services can severely affect international competitiveness. However, the evidence lacks the overall impact of logistics performance-encompassing all inventory, warehousing, and transport components- on global trade. In order to fill this knowledge gap, the paper uses a gravitational trade model with 155 countries from all geographical regions between 2007 and 2018. Data on logistics performance is obtained from the World Bank's Logistics Performance Index (LPI). First, the relationship between logistics performance and a country’s total trade is estimated, followed by a breakdown by the economic sector. Then, the analysis is disaggregated according to the level of technological intensity of traded goods. Finally, after evaluating the intensive margin of trade, the relevance of logistics infrastructure and services for the extensive trade margin is assessed. Results suggest that: (i) improvements in both logistics infrastructure and services are associated with export growth; (ii) manufactured goods can significantly benefit from these improvements, especially when both exporting and importing countries increase their logistics performance; (iii) the quality of logistics infrastructure and services becomes more important as traded goods are technology-intensive; and (iv) improving the exporting country's logistics performance is essential in the intensive margin of trade while enhancing the importing country's logistics performance is more relevant in the extensive margin.

Keywords: gravity models, infrastructure, international trade, logistics

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1892 In-Silico Fusion of Bacillus Licheniformis Chitin Deacetylase with Chitin Binding Domains from Chitinases

Authors: Keyur Raval, Steffen Krohn, Bruno Moerschbacher

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Chitin, the biopolymer of the N-acetylglucosamine, is the most abundant biopolymer on the planet after cellulose. Industrially, chitin is isolated and purified from the shell residues of shrimps. A deacetylated derivative of chitin i.e. chitosan has more market value and applications owing to it solubility and overall cationic charge compared to the parent polymer. This deacetylation on an industrial scale is performed chemically using alkalis like sodium hydroxide. This reaction not only is hazardous to the environment owing to negative impact on the marine ecosystem. A greener option to this process is the enzymatic process. In nature, the naïve chitin is converted to chitosan by chitin deacetylase (CDA). This enzymatic conversion on the industrial scale is however hampered by the crystallinity of chitin. Thus, this enzymatic action requires the substrate i.e. chitin to be soluble which is technically difficult and an energy consuming process. We in this project wanted to address this shortcoming of CDA. In lieu of this, we have modeled a fusion protein with CDA and an auxiliary protein. The main interest being to increase the accessibility of the enzyme towards crystalline chitin. A similar fusion work with chitinases had improved the catalytic ability towards insoluble chitin. In the first step, suitable partners were searched through the protein data bank (PDB) wherein the domain architecture were sought. The next step was to create the models of the fused product using various in silico techniques. The models were created by MODELLER and evaluated for properties such as the energy or the impairment of the binding sites. A fusion PCR has been designed based on the linker sequences generated by MODELLER and would be tested for its activity towards insoluble chitin.

Keywords: chitin deacetylase, modeling, chitin binding domain, chitinases

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1891 Biodiversity and Climate Change: Consequences for Norway Spruce Mountain Forests in Slovakia

Authors: Jozef Mindas, Jaroslav Skvarenina, Jana Skvareninova

Abstract:

Study of the effects of climate change on Norway Spruce (Picea abies) forests has mainly focused on the diversity of tree species diversity of tree species as a result of the ability of species to tolerate temperature and moisture changes as well as some effects of disturbance regime changes. The tree species’ diversity changes in spruce forests due to climate change have been analyzed via gap model. Forest gap model is a dynamic model for calculation basic characteristics of individual forest trees. Input ecological data for model calculations have been taken from the permanent research plots located in primeval forests in mountainous regions in Slovakia. The results of regional scenarios of the climatic change for the territory of Slovakia have been used, from which the values are according to the CGCM3.1 (global) model, KNMI and MPI (regional) models. Model results for conditions of the climate change scenarios suggest a shift of the upper forest limit to the region of the present subalpine zone, in supramontane zone. N. spruce representation will decrease at the expense of beech and precious broadleaved species (Acer sp., Sorbus sp., Fraxinus sp.). The most significant tree species diversity changes have been identified for the upper tree line and current belt of dwarf pine (Pinus mugo) occurrence. The results have been also discussed in relation to most important disturbances (wind storms, snow and ice storms) and phenological changes which consequences are little known. Special discussion is focused on biomass production changes in relation to carbon storage diversity in different carbon pools.

Keywords: biodiversity, climate change, Norway spruce forests, gap model

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1890 Post-Secondary Faculty Treatment of Non-Native English-Speaking Student Writing Errors in Academic Subject Courses

Authors: Laura E. Monroe

Abstract:

As more non-native English-speaking students enroll in English-medium universities, even more faculty will instruct students who are unprepared for the rigors of post-secondary academic writing in English. Many faculty members lack training and knowledge regarding the assessment of non-native English-speaking students’ writing, as well as the ability to provide effective feedback. This quantitative study investigated the possible attitudinal factors, including demographics, which might affect faculty preparedness and grading practices for both native and non-native English-speaking students’ academic writing and plagiarism, as well as the reasons faculty do not deduct points from both populations’ writing errors. Structural equation modeling and SPSS Statistics were employed to analyze the results of a faculty questionnaire disseminated to individuals who had taught non-native English-speaking students in academic subject courses. The findings from this study illustrated that faculty’s native language, years taught, and institution type were significant factors in not deducting points for academic writing errors and plagiarism, and the major reasons for not deducting points for errors were that faculty had too many students to grade, not enough training in assessing student written errors and plagiarism and that the errors and plagiarism would have taken too long to explain. The practical implications gleaned from these results can be applied to most departments in English-medium post-secondary institutions regarding faculty preparedness and training in student academic writing errors and plagiarism, and recommendations for future research are given for similar types of preparation and guidance for post-secondary faculty, regardless of degree path or academic subject.

Keywords: assessment, faculty, non-native English-speaking students, writing

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1889 Integration of GIS with Remote Sensing and GPS for Disaster Mitigation

Authors: Sikander Nawaz Khan

Abstract:

Natural disasters like flood, earthquake, cyclone, volcanic eruption and others are causing immense losses to the property and lives every year. Current status and actual loss information of natural hazards can be determined and also prediction for next probable disasters can be made using different remote sensing and mapping technologies. Global Positioning System (GPS) calculates the exact position of damage. It can also communicate with wireless sensor nodes embedded in potentially dangerous places. GPS provide precise and accurate locations and other related information like speed, track, direction and distance of target object to emergency responders. Remote Sensing facilitates to map damages without having physical contact with target area. Now with the addition of more remote sensing satellites and other advancements, early warning system is used very efficiently. Remote sensing is being used both at local and global scale. High Resolution Satellite Imagery (HRSI), airborne remote sensing and space-borne remote sensing is playing vital role in disaster management. Early on Geographic Information System (GIS) was used to collect, arrange, and map the spatial information but now it has capability to analyze spatial data. This analytical ability of GIS is the main cause of its adaption by different emergency services providers like police and ambulance service. Full potential of these so called 3S technologies cannot be used in alone. Integration of GPS and other remote sensing techniques with GIS has pointed new horizons in modeling of earth science activities. Many remote sensing cases including Asian Ocean Tsunami in 2004, Mount Mangart landslides and Pakistan-India earthquake in 2005 are described in this paper.

Keywords: disaster mitigation, GIS, GPS, remote sensing

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1888 Design and Implementation of Control System in Underwater Glider of Ganeshblue

Authors: Imam Taufiqurrahman, Anugrah Adiwilaga, Egi Hidayat, Bambang Riyanto Trilaksono

Abstract:

Autonomous Underwater Vehicle glider is one of the renewal of underwater vehicles. This vehicle is one of the autonomous underwater vehicles that are being developed in Indonesia. Glide ability is obtained by controlling the buoyancy and attitude of the vehicle using the movers within the vehicle. The glider motion mechanism is expected to provide energy resistance from autonomous underwater vehicles so as to increase the cruising range of rides while performing missions. The control system on the vehicle consists of three parts: controlling the attitude of the pitch, the buoyancy engine controller and the yaw controller. The buoyancy and pitch controls on the vehicle are sequentially referring to the finite state machine with pitch angle and depth of diving inputs to obtain a gliding cycle. While the yaw control is done through the rudder for the needs of the guide system. This research is focused on design and implementation of control system of Autonomous Underwater Vehicle glider based on PID anti-windup. The control system is implemented on an ARM TS-7250-V2 device along with a mathematical model of the vehicle in MATLAB using the hardware-in-the-loop simulation (HILS) method. The TS-7250-V2 is chosen because it complies industry standards, has high computing capability, minimal power consumption. The results show that the control system in HILS process can form glide cycle with depth and angle of operation as desired. In the implementation using half control and full control mode, from the experiment can be concluded in full control mode more precision when tracking the reference. While half control mode is considered more efficient in carrying out the mission.

Keywords: control system, PID, underwater glider, marine robotics

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1887 Written Narrative Texts as the Indicators of Communication Competence of Pupils and Students with Hearing Impairment in the Czech Language

Authors: Marie Komorna, Katerina Hadkova

Abstract:

One reason why hearing disabilities as compared to other disabilities are considered to be less serious, is the belief that deaf and hard of hearing persons can read and write without problems and can therefore fairly easily compensate for problems related to their limited ability to hear sound. However in reality this is not the case, especially as regards written Czech, deaf persons are often not able to communicate their message clearly to its recipients. Their inability to communicate fully in written language is one of the most severe problems facing a number of deaf persons, a problem which they face and which makes it difficult for them to function in a sound-based environment. Despite this fact, this issue is one which has been given only a minimum of attention in the Czech Republic. That is why we decided to focus our research on this issue, specifically targeting written communication of deaf pupils in primary and secondary schools. The paper summarizes the background and objectives of this research. The written work of deaf respondents was obtained in response to a narrative based on a series of images which depicted a continuous storyline. Based on an analysis of the obtained written work we tried to describe the specifics of the narrative abilities of the deaf authors of these texts. We also analyzed other aspects and specific traits of text written by deaf authors at a phonetic-phonological, lexical-semantic, morphological and syntactic, respectively pragmatic level. Based on the results of the project it will be possible to increase knowledge of the communication abilities of deaf persons in written Czech. The obtained data may be used during future research and for teaching purposes and/or education concepts for teaching Czech to deaf pupils.

Keywords: communication competence, deaf, narrative, written texts

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1886 Implementation of Real-World Learning Experiences in Teaching Courses of Medical Microbiology and Dietetics for Health Science Students

Authors: Miriam I. Jimenez-Perez, Mariana C. Orellana-Haro, Carolina Guzman-Brambila

Abstract:

As part of microbiology and dietetics courses, students of medicine and nutrition analyze the main pathogenic microorganisms and perform dietary analyzes. The course of microbiology describes in a general way the main pathogens including bacteria, viruses, fungi, and parasites, as well as their interaction with the human species. We hypothesize that lack of practical application of the course causes the students not to find the value and the clinical application of it when in reality it is a matter of great importance for healthcare in our country. The courses of the medical microbiology and dietetics are mostly theoretical and only a few hours of laboratory practices. Therefore, it is necessary the incorporation of new innovative techniques that involve more practices and community fieldwork, real cases analysis and real-life situations. The purpose of this intervention was to incorporate real-world learning experiences in the instruction of medical microbiology and dietetics courses, in order to improve the learning process, understanding and the application in the field. During a period of 6 months, medicine and nutrition students worked in a community of urban poverty. We worked with 90 children between 4 and 6 years of age from low-income families with no access to medical services, to give an infectious diagnosis related to nutritional status in these children. We expect that this intervention would give a different kind of context to medical microbiology and dietetics students improving their learning process, applying their knowledge and laboratory practices to help a needed community. First, students learned basic skills in microbiology diagnosis test during laboratory sessions. Once, students acquired abilities to make biochemical probes and handle biological samples, they went to the community and took stool samples from children (with the corresponding informed consent). Students processed the samples in the laboratory, searching for enteropathogenic microorganism with RapID™ ONE system (Thermo Scientific™) and parasites using Willis and Malloy modified technique. Finally, they compared the results with the nutritional status of the children, previously measured by anthropometric indicators. The anthropometric results were interpreted by the OMS Anthro software (WHO, 2011). The microbiological result was interpreted by ERIC® Electronic RapID™ Code Compendium software and validated by a physician. The results were analyses of infectious outcomes and nutritional status. Related to fieldwork community learning experiences, our students improved their knowledge in microbiology and were capable of applying this knowledge in a real-life situation. They found this kind of learning useful when they translate theory to a real-life situation. For most of our students, this is their first contact as health caregivers with real population, and this contact is very important to help them understand the reality of many people in Mexico. In conclusion, real-world or fieldwork learning experiences empower our students to have a real and better understanding of how they can apply their knowledge in microbiology and dietetics and help a much- needed population, this is the kind of reality that many people live in our country.

Keywords: real-world learning experiences, medical microbiology, dietetics, nutritional status, infectious status.

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1885 Disability and Sexuality: A Human Right Approach to Sexual and Reproductive Health of the Hearing Impaired Adolescents In Developing Countries

Authors: Doctor Akanle Florence Foluso

Abstract:

Access to health care and people’s ability to having a responsible, satisfying and safe sexual life is clearly a defined human right of people with hearing impairment and others with disabilities this paper looks at disability and sexuality: a human right approach to sexual and reproductive health of the hearing impaired adolescents in developing countries. This paper investigates the extent to which the hearing impaired has a satisfying, safe sexual life and whether their human right in regards to information education is violated. The study population consists of all hearing impaired adolescents and young adults aged 10-24 years who are currently enrolled in the primary and secondary schools in Nigeria. A sample of 389 hearing impaired adolescents was selected, an adapted version of the illustrative questionnaire for interview – survey by Johncleland was used to collect the data. A correlation of 0.80 was obtained at p<0.05 level of significance. Teachers in the schools of the deaf who used sign language were used in the administration of the questionnaire. The data generated were analyzed using Frequency Counts, Percentages, Means and Standard Deviation to give a Summary on responses on access to information, education, voluntary testing and counselling and other reproductive services. This is to investigate if the sexual and reproductive right violated or protected. Findings show that a gap exists in the level of knowledge of SRH services, voluntary counselling because more than half the respondents are not aware of these services in their community. Access to information, education and health services are rights denied the hearing impaired. So their SRH rights are violated.

Keywords: sexual right diability, family planning, pregnancy, diability

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1884 Developing a Model of Teaching Writing Based On Reading Approach through Reflection Strategy for EFL Students of STKIP YPUP

Authors: Eny Syatriana, Ardiansyah

Abstract:

The purpose of recent study was to develop a learning model on writing, based on the reading texts which will be read by the students using reflection strategy. The strategy would allow the students to read the text and then they would write back the main idea and to develop the text by using their own sentences. So, the writing practice was begun by reading an interesting text, then the students would develop the text which has been read into their writing. The problem questions are (1) what kind of learning model that can develop the students writing ability? (2) what is the achievement of the students of STKIP YPUP through reflection strategy? (3) is the using of the strategy effective to develop students competence In writing? (4) in what level are the students interest toward the using of a strategy In writing subject? This development research consisted of some steps, they are (1) need analysis (2) model design (3) implementation (4) model evaluation. The need analysis was applied through discussion among the writing lecturers to create a learning model for writing subject. To see the effectiveness of the model, an experiment would be delivered for one class. The instrument and learning material would be validated by the experts. In every steps of material development, there was a learning process, where would be validated by an expert. The research used development design. These Principles and procedures or research design and development .This study, researcher would do need analysis, creating prototype, content validation, and limited empiric experiment to the sample. In each steps, there should be an assessment and revision to the drafts before continue to the next steps. The second year, the prototype would be tested empirically to four classes in STKIP YPUP for English department. Implementing the test greatly was done through the action research and followed by evaluation and validation from the experts.

Keywords: learning model, reflection, strategy, reading, writing, development

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1883 Evaluating Cyanide Biodegradation by Bacteria Isolated from Gold Mine Effluents in Bulawayo, Zimbabwe

Authors: Ngonidzashe Mangoma, Caroline Marigold Sebata

Abstract:

The release of cyanide-rich effluents from gold mines, and other industries, into the environment, is a global concern considering the well-known metabolic effects of cyanide in all forms of life. Such effluents need to be treated to remove cyanide, among other pollutants, before their disposal. This study aimed at investigating the possible use of bacteria in the biological removal of cyanide from cyanide-rich effluents. Firstly, cyanide-degrading bacteria were isolated from gold mine effluents and characterised. The isolates were then tested for their ability to grow in the presence of cyanide and their tolerance to increasing levels of the compound. To evaluate each isolate’s cyanide-degrading activities, isolates were grown in the simulated and actual effluent, and a titrimetric method was used to quantify residual cyanide over a number of days. Cyanide degradation efficiency (DE) was then calculated for each isolate. Identification of positive isolates involved 16S rRNA gene amplification and sequence analysis through BLAST. Six cyanide-utilising bacterial strains were isolated. Two of the isolates were identified as Klebsiella spp. while the other two were shown to be different strains of Clostridium bifermentans. All isolates showed normal growth in the presence of cyanide, with growth being inhibited at 700 mg/L cyanide and beyond. Cyanide degradation efficiency for all isolates in the simulated effluent ranged from 79% to 97%. All isolates were able to remove cyanide from actual gold mine effluent with very high DE values (90 – 94%) being recorded. Isolates obtained in this study were able to efficiently remove cyanide from both simulated and actual effluent. This observation clearly demonstrates the feasibility of the biological removal of cyanide from cyanide-rich gold mine effluents and should, therefore, motivate research towards the possible large-scale application of this technology.

Keywords: cyanide effluent, bioremediation, Clostridium bifermentans, Klebsiella spp, environment

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1882 Full-Face Hyaluronic Acid Implants Assisted by Artificial Intelligence-Generated Post-treatment 3D Models

Authors: Ciro Cursio, Pio Luigi Cursio, Giulia Cursio, Isabella Chiardi, Luigi Cursio

Abstract:

Introduction: Full-face aesthetic treatments often present a difficult task: since different patients possess different anatomical and tissue characteristics, there is no guarantee that the same treatment will have the same effect on multiple patients; additionally, full-face rejuvenation and beautification treatments require not only a high degree of technical skill but also the ability to choose the right product for each area and a keen artistic eye. Method: We present an artificial intelligence-based algorithm that can generate realistic post-treatment 3D models based on the patient’s requests together with the doctor’s input. These 3-dimensional predictions can be used by the practitioner for two purposes: firstly, they help ensure that the patient and the doctor are completely aligned on the expectations of the treatment; secondly, the doctor can use them as a visual guide, obtaining a natural result that would normally stem from the practitioner's artistic skills. To this end, the algorithm is able to predict injection zones, the type and quantity of hyaluronic acid, the injection depth, and the technique to use. Results: Our innovation consists in providing an objective visual representation of the patient that is helpful in the patient-doctor dialogue. The patient, based on this information, can express her desire to undergo a specific treatment or make changes to the therapeutic plan. In short, the patient becomes an active agent in the choices made before the treatment. Conclusion: We believe that this algorithm will reveal itself as a useful tool in the pre-treatment decision-making process to prevent both the patient and the doctor from making a leap into the dark.

Keywords: hyaluronic acid, fillers, full face, artificial intelligence, 3D

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1881 Humoral and Cytokine Responses to Major Human Cytomegalovirus Antigens in Mouse Model

Authors: Sahar Essa, Hussain A. Safar, Raj Raghupathy

Abstract:

Human cytomegalovirus (CMV) continues to be a source of severe complications in immunologically immature and immunocompromised hosts. Effective CMV vaccines that help diminish CMV disease in transplant patients and avoid congenital infection are of great importance. Though the exact roles of defense mechanisms are unidentified, viral-specific antibodies and cytokine responses are known to be involved in controlling CMV infections. CMV envelope glycoprotein B (UL55/gB), matrix proteins (UL83/pp65, UL99/pp28, UL32/pp150), and assembly protein UL80a/pp38 are known to be targets of antiviral immune responses. We immunized mice intraperitoneally with these five CMV-related proteins (commercial) for their ability to induce specific antibody responses (in-house immunoassay) and cytokine production (commercial assay) in a mouse model. We observed a significant CMV-antigen-specific antibody response to pp38 and pp65 (E/C ˃2.0, p˂0.001). Mice immunized with pp38 had significantly higher concentrations of GM-CSF, IFN-α, IL-2 IL-4, IL-5, and IL-17A (p˂0.05). Mice immunized with pp65 showed significantly higher concentrations of GM-CSF, IFN-γ, IL-2 IL-4, IL-10, IL-12, IL-17A, and TNF-α. Th1 to Th2 cytokines ratios revealed a Th1 cytokine bias in mice immunized with pp38, pp65, pp150, and gB. We suggest that stimulation with multiple CMV-related proteins, which include pp38, pp65, and gB antigens, will allow both humoral and cellular immune responses to be efficiently activated, thus serving as appropriate CMV antigens for future vaccines.

Keywords: cytomegalovirus, UL99/pp28, UL80a/pp38, UL83/pp65, UL32/pp150, UL55/gB, CMV-antigen-specific antibody, CMV antigen-specific cytokine responses

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1880 Evaluation of Water-Soluble Ionic Liquids Based on Quaternized Hyperbranched Polyamidoamine and Amino Acids for Chemical Enhanced Oil Recovery

Authors: Rasha Hosny, Ahmed Zahran, Mahmoud Ramzi, Fatma Mahmoud Abdelhafiz, Ammona S. Mohamed, Mahmoud Fathy Mubarak

Abstract:

Ionic liquids' ability to be tuned and stability under challenging environmental conditions are their significant features in enhanced oil recovery. In this study, two amino acid ionic liquids (AAILs) were prepared from quaternized hyperbranched polyamidoamine PAMAM (G0.5 C12) and amino acids (Cysteine and Lysine). The chemical structures of the prepared AAILs were verified by using FTIR and 1H-NMR spectra. These AAILs were tested for solubility, thermal stability, and surface activity in the presence of Egyptian medium crude oils under different PVT parameters after being diluted in several brine solutions of various salt compositions at 10% (w/w) salinity. The measurements reveal that the produced AAILs have good solubility and thermal stability. The effect of different concentrations of AAILs (0.1-5%) and salinity (20000-70000 ppm) on Interfacial tension (IFT) were studied. To test the efficacy of (AAILs) for a CEOR, numerous flooding experiments were carried out in samples of sandstone rock. Rock wettability is important for sandstone rocks, so conduct wettability alteration by contact angle (CA) of (30-55) and IFT of (7-13). The additional oil recovery was largely influenced by ionic liquid concentration, which may be changed by dilution with the formation and injected brines. This research has demonstrated that EOR techniques led to a recovery wt. (22-45%).

Keywords: amino acid ionic liquids, surface activity, critical micelle concentration, interfacial tension, contact angle, chemical enhanced oil recovery, wettability

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1879 Endometrial Ablation and Resection Versus Hysterectomy for Heavy Menstrual Bleeding: A Systematic Review and Meta-Analysis of Effectiveness and Complications

Authors: Iliana Georganta, Clare Deehan, Marysia Thomson, Miriam McDonald, Kerrie McNulty, Anna Strachan, Elizabeth Anderson, Alyaa Mostafa

Abstract:

Context: A meta-analysis of randomized controlled trials (RCTs) comparing hysterectomy versus endometrial ablation and resection in the management of heavy menstrual bleeding. Objective: To evaluate the clinical efficacy, satisfaction rates and adverse events of hysterectomy compared to more minimally invasive techniques in the treatment of HMB. Evidence Acquisition: A literature search was performed for all RCTs and quasi-RCTs comparing hysterectomy with either endometrial ablation endometrial resection of both. The search had no language restrictions and was last updated in June 2020 using MEDLINE, EMBASE, Cochrane Central Register of Clinical Trials, PubMed, Google Scholar, PsycINFO, Clinicaltrials.gov and Clinical trials. EU. In addition, a manual search of the abstract databases of the European Haemophilia Conference on women's health was performed and further studies were identified from references of acquired papers. The primary outcomes were patient-reported and objective reduction in heavy menstrual bleeding up to 2 years and after 2 years. Secondary outcomes included satisfaction rates, pain, adverse events short and long term, quality of life and sexual function, further surgery, duration of surgery and hospital stay and time to return to work and normal activities. Data were analysed using RevMan software. Evidence synthesis: 12 studies and a total of 2028 women were included (hysterectomy: n = 977 women vs endometrial ablation or resection: n = 1051 women). Hysterectomy was compared with endometrial ablation only in five studies (Lin, Dickersin, Sesti, Jain, Cooper) and endometrial resection only in five studies (Gannon, Schulpher, O’Connor, Crosignani, Zupi) and a mixture of the Ablation and Resection in two studies (Elmantwe, Pinion). Of the 1² studies, 10 reported women’s perception of bleeding symptoms as improved. Meta-analysis showed that women in the hysterectomy group were more likely to show improvement in bleeding symptoms when compared with endometrial ablation or resection up to 2-year follow-up (RR 0.75, 95% CI 0.71 to 0.79, I² = 95%). Objective outcomes of improvement in bleeding also favored hysterectomy. Patient satisfaction was higher after hysterectomy within the 2 years follow-up (RR: 0.90, 95%CI: 0.86 to 0.94, I²:58%), however, there was no significant difference between the two groups at more than 2 years follow up. Sepsis (RR: 0.03, 95% CI 0.002 to 0.56; 1 study), wound infection (RR: 0.05, 95% CI: 0.01 to 0.28, I²: 0%, 3 studies) and Urinary tract infection (UTI) (RR: 0.20, 95% CI: 0.10 to 0.42, I²: 0%, 4 studies) all favoured hysteroscopic techniques. Fluid overload (RR: 7.80, 95% CI: 2.16 to 28.16, I² :0%, 4 studies) and perforation (RR: 5.42, 95% CI: 1.25 to 23.45, I²: 0%, 4 studies) however favoured hysterectomy in the short term. Conclusions: This meta-analysis has demonstrated that endometrial ablation and endometrial resection are both viable options when compared with hysterectomy for the treatment of heavy menstrual bleeding. Hysteroscopic procedures had better outcomes in the short term with fewer adverse events including wound infection, UTI and sepsis. The hysterectomy performed better when measuring more long-term impacts such as recurrence of symptoms, overall satisfaction at two years and the need for further treatment or surgery.

Keywords: menorrhagia, hysterectomy, ablation, resection

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