Search results for: local complications
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 6150

Search results for: local complications

2430 Preschoolers’ Involvement in Indoor and Outdoor Learning Activities as Predictors of Social Learning Skills in Niger State, Nigeria

Authors: Okoh Charity N.

Abstract:

This study investigated the predictive power of preschoolers’ involvement in indoor and outdoor learning activities on their social learning skills in Niger state, Nigeria. Two research questions and two null hypotheses guided the study. Correlational research design was employed in the study. The population of the study consisted of 8,568 Nursery III preschoolers across the 549 preschools in the five Local Education Authorities in Niger State. A sample of 390 preschoolers drawn through multistage sampling procedure. Two instruments; Preschoolers’ Learning Activities Rating Scale (PLARS) and Preschoolers’ Social Learning Skills Rating Scale (PSLSRS) developed by the researcher were used for data collection. The reliability coefficients obtained for the PLARS and PSLSRS were 0.83 and 0.82, respectively. Data collected were analyzed using simple linear regression. Results showed that 37% of preschoolers’ social learning skills are predicted by their involvement in indoor learning activities, which is statistically significant (p < 0.05). It also shows that 11% of preschoolers’ social learning skills are predicted by their involvement in outdoor learning activities, which is statistically significant (p < 0.05). Therefore, it was recommended among others, that government and school administrators should employ qualified teachers who will stand as role models for preschoolers’ social skills development and provide indoor and outdoor activities and materials for preschoolers in schools.

Keywords: preschooler, social learning, indoor activities, outdoor activities

Procedia PDF Downloads 102
2429 The Monitor for Neutron Dose in Hadrontherapy Project: Secondary Neutron Measurement in Particle Therapy

Authors: V. Giacometti, R. Mirabelli, V. Patera, D. Pinci, A. Sarti, A. Sciubba, G. Traini, M. Marafini

Abstract:

The particle therapy (PT) is a very modern technique of non invasive radiotherapy mainly devoted to the treatment of tumours untreatable with surgery or conventional radiotherapy, because localised closely to organ at risk (OaR). Nowadays, PT is available in about 55 centres in the word and only the 20\% of them are able to treat with carbon ion beam. However, the efficiency of the ion-beam treatments is so impressive that many new centres are in construction. The interest in this powerful technology lies to the main characteristic of PT: the high irradiation precision and conformity of the dose released to the tumour with the simultaneous preservation of the adjacent healthy tissue. However, the beam interactions with the patient produce a large component of secondary particles whose additional dose has to be taken into account during the definition of the treatment planning. Despite, the largest fraction of the dose is released to the tumour volume, a non-negligible amount is deposed in other body regions, mainly due to the scattering and nuclear interactions of the neutrons within the patient body. One of the main concerns in PT treatments is the possible occurrence of secondary malignant neoplasm (SMN). While SMNs can be developed up to decades after the treatments, their incidence impacts directly life quality of the cancer survivors, in particular in pediatric patients. Dedicated Treatment Planning Systems (TPS) are used to predict the normal tissue toxicity including the risk of late complications induced by the additional dose released by secondary neutrons. However, no precise measurement of secondary neutrons flux is available, as well as their energy and angular distributions: an accurate characterization is needed in order to improve TPS and reduce safety margins. The project MONDO (MOnitor for Neutron Dose in hadrOntherapy) is devoted to the construction of a secondary neutron tracker tailored to the characterization of that secondary neutron component. The detector, based on the tracking of the recoil protons produced in double-elastic scattering interactions, is a matrix of thin scintillating fibres, arranged in layer x-y oriented. The final size of the object is 10 x 10 x 20 cm3 (squared 250µm scint. fibres, double cladding). The readout of the fibres is carried out with a dedicated SPAD Array Sensor (SBAM) realised in CMOS technology by FBK (Fondazione Bruno Kessler). The detector is under development as well as the SBAM sensor and it is expected to be fully constructed for the end of the year. MONDO will make data tacking campaigns at the TIFPA Proton Therapy Center of Trento, at the CNAO (Pavia) and at HIT (Heidelberg) with carbon ion in order to characterize the neutron component and predict the additional dose delivered on the patients with much more precision and to drastically reduce the actual safety margins. Preliminary measurements with charged particles beams and MonteCarlo FLUKA simulation will be presented.

Keywords: secondary neutrons, particle therapy, tracking detector, elastic scattering

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2428 Robust Decision Support Framework for Addressing Uncertainties in Water Resources Management in the Mekong

Authors: Chusit Apirumanekul, Chayanis Krittasudthacheewa, Ratchapat Ratanavaraha, Yanyong Inmuong

Abstract:

Rapid economic development in the Lower Mekong region is leading to changes in water quantity and quality. Changes in land- and forest-use, infrastructure development, increasing urbanization, migration patterns and climate risks are increasing demands for water, within various sectors, placing pressure on scarce water resources. Appropriate policies, strategies, and planning are urgently needed for improved water resource management. Over the last decade, Thailand has experienced more frequent and intense drought situations, affecting the level of water storage in reservoirs along with insufficient water allocation for agriculture during the dry season. The Huay Saibat River Basin, one of the well-known water-scarce areas in the northeastern region of Thailand, is experiencing ongoing water scarcity that affects both farming livelihoods and household consumption. Drought management in Thailand mainly focuses on emergency responses, rather than advance preparation and mitigation for long-term solutions. Despite many efforts from local authorities to mitigate the drought situation, there is yet no long-term comprehensive water management strategy, that integrates climate risks alongside other uncertainties. This paper assesses the application in the Huay Saibat River Basin, of the Robust Decision Support framework, to explore the feasibility of multiple drought management policies; including a shift in cropping season, in crop changes, in infrastructural operations and in the use of groundwater, under a wide range of uncertainties, including climate and land-use change. A series of consultative meetings were organized with relevant agencies and experts at the local level, to understand and explore plausible water resources strategies and identify thresholds to evaluate the performance of those strategies. Three different climate conditions were identified (dry, normal and wet). Other non-climatic factors influencing water allocation were further identified, including changes from sugarcane to rubber, delaying rice planting, increasing natural retention storage and using groundwater to supply demands for household consumption and small-scale gardening. Water allocation and water use in various sectors, such as in agriculture, domestic, industry and the environment, were estimated by utilising the Water Evaluation And Planning (WEAP) system, under various scenarios developed from the combination of climatic and non-climatic factors mentioned earlier. Water coverage (i.e. percentage of water demand being successfully supplied) was defined as a threshold for water resource strategy assessment. Thresholds for different sectors (agriculture, domestic, industry, and environment) were specified during multi-stakeholder engagements. Plausible water strategies (e.g. increasing natural retention storage, change of crop type and use of groundwater as an alternative source) were evaluated based on specified thresholds in 4 sectors (agriculture, domestic, industry, and environment) under 3 climate conditions. 'Business as usual' was evaluated for comparison. The strategies considered robust, emerge when performance is assessed as successful, under a wide range of uncertainties across the river basin. Without adopting any strategy, the water scarcity situation is likely to escalate in the future. Among the strategies identified, the use of groundwater as an alternative source was considered a potential option in combating water scarcity for the basin. Further studies are needed to explore the feasibility for groundwater use as a potential sustainable source.

Keywords: climate change, robust decision support, scenarios, water resources management

Procedia PDF Downloads 156
2427 Greening of the Hotel Industry in Malawi: An Examination of the Governance and Policing Tools

Authors: Lameck Zetu Khonje, Mulala Danny Simatele

Abstract:

Malawi’s economy is agriculture based. Recently the government earmarked the tourism sector as an important economic sector which could support the agriculture sector to bring about sustainable economic development and help socioeconomic wellbeing of the local people. Greening of the hotel industry is one of the proven ideal ways of creating a sustainable tourism industry which brings about sustainable economic development in a country like Malawi. This study uses qualitative methodology to examine the efficacy of the governance and policing tools that Malawi uses to guide the development and general practices of the hotel sector to ascertain whether these tools are for greening or not. Grounded Theory method is used whereby semi-structured interviews and field visits were conducted to collect data for the study. The results of the study show that there are loopholes in the governance system in Malawi. The results also reveal gaps within the policing tools such that the hotel industry is not properly guided on green issues. Furthermore, the results show that there is a lack of collaboration for the enforcement of the green practices in the hotel industry. It is also revealed that there is a lack of knowledge of green issues within the governance structures. Awareness campaigns and capacity building would improve greening of the hotel industry in Malawi.

Keywords: governance, greening, Grounded Theory, Malawi

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2426 The Elastic Field of a Nano-Pore, and the Effective Modulus of Composites with Nano-Pores

Authors: Xin Chen, Moxiao Li, Xuechao Sun, Fei Ti, Shaobao Liu, Feng Xu, Tian Jian Lu

Abstract:

The composite materials with pores have the characteristics of light weight, sound insulation, and heat insulation, and have broad prospects in many fields, including aerospace. In general, the stiffness of such composite is less than the stiffness of the matrix material, limiting their applications. In this paper, we establish a theoretical model to analyze the deformation mechanism of a nano-pore. The interface between the pores and matrix material is described by the Gurtin-Murdoch model. By considering scale effect related with current deformation, we estimate the effective mechanical properties (e.g., effective shear modulus and bulk modulus) of a composite with nano-pores. Due to the scale effect, the elastic field in the composite was changed and local hardening was observed around the nano-pore, and the effective shear modulus and effective bulk modulus were found to be a function of the surface energy. The effective shear modulus increase with the surface energy and decrease with the size of the nano-pores, and the effective bulk modulus decrease with the surface energy and increase with the size of the nano-pores. These results have potential applications in the nanocomposite mechanics and aerospace field.

Keywords: composite mechanics, nano-inhomogeneity, nano-pores, scale effect

Procedia PDF Downloads 123
2425 Assessment the Impact of Changes in Cultivation Pattern from Grape to Apple on Drying up of Urmia Lake

Authors: Nasser Karami

Abstract:

The Urmia grapes have been famous for centuries and have been among the most desirable in the production of wine. Interestingly, evidence shows that the Urmia region was the first place in the world where wine was produced and consumed. In fact, the grapes known as “Shiraz” and made popular by “Shiraz Wine” are the grapes cultivated as a local species especially in the West Azerbaijan watershed basin and exported to Europe. But after the Islamic Revolution, because the production, usage, and sale of wine were unlawful (under Islamic rule), they decided to cultivate apples instead of grapes. Before Islamic revolution, about 50 percent of the gardens were producing grapes, but the apple groves took up less than 1.5 percent (100 hectares). Three years after the revolution, in 1982, people were swept up in the revolutionary excitement and grape cultivation decreased, using less than 10 percent of the garden area. Important is the fact that an apple tree needs 12 times more water than a grapevine, it should be noted that in terms of water usage in the area, the agricultural area has not been increased by 2 or 4 times but rather by 12 times. Evaluation of this study showed that contrary to official reports, climate change isn’t major cause of drying up Urmia Lake and 65 percent of this environmental crisis happened due to spreading unsustainable agricultural in basin of this lake.

Keywords: cultivation pattern, unsustainable agriculture, urmia lake drying, water managment

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2424 Historic Urban Landscape Approach, a Methodology to Elaborate Sustainable Development Plans through Culture and Heritage: The Case Study of Valverde de Burguillos (Spain)

Authors: Julia Rey Perez, Victoria Dominguez Ruiz

Abstract:

The phenomenon of depopulation puts the authorities at risk of abandoning a number of rural-urban areas of significant cultural value, affecting their architecture and intangible cultural heritage. The purpose of this research is to present a methodology created according to the UNESCO Recommendation on the Historic Urban Landscape (HUL), which through the identification of cultural values and attributes, leads to ´Strategic Plans´ build upon the culture and heritage. This methodology is based on the analysis of the town from three perspectives: 1) from the public administration, 2) from the discipline of architecture, and 3) from citizen perception. In order to be able to work on the development of a diagnosis from three very different approaches, collaborative cartographies have been used as working tools. The methodology discussed was applied in Valverde de Burguillos, in Spain, leading to the construction of an inclusive ‘Strategic Plan’ that integrates the management of the town within the overall territorial development plan. The importance of incorporating culture and heritage as a conductor for sustainable urban development through the HUL approach has allowed the local authorities to assume these new tools for heritage conservation, acknowledging community participation as the main element for the ´Strategic Plan” elaboration.

Keywords: rural heritage, citizen participation, inclusiveness, urban governance, UNESCO

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2423 Mobi-DiQ: A Pervasive Sensing System for Delirium Risk Assessment in Intensive Care Unit

Authors: Subhash Nerella, Ziyuan Guan, Azra Bihorac, Parisa Rashidi

Abstract:

Intensive care units (ICUs) provide care to critically ill patients in severe and life-threatening conditions. However, patient monitoring in the ICU is limited by the time and resource constraints imposed on healthcare providers. Many critical care indices such as mobility are still manually assessed, which can be subjective, prone to human errors, and lack granularity. Other important aspects, such as environmental factors, are not monitored at all. For example, critically ill patients often experience circadian disruptions due to the absence of effective environmental “timekeepers” such as the light/dark cycle and the systemic effect of acute illness on chronobiologic markers. Although the occurrence of delirium is associated with circadian disruption risk factors, these factors are not routinely monitored in the ICU. Hence, there is a critical unmet need to develop systems for precise and real-time assessment through novel enabling technologies. We have developed the mobility and circadian disruption quantification system (Mobi-DiQ) by augmenting biomarker and clinical data with pervasive sensing data to generate mobility and circadian cues related to mobility, nightly disruptions, and light and noise exposure. We hypothesize that Mobi-DiQ can provide accurate mobility and circadian cues that correlate with bedside clinical mobility assessments and circadian biomarkers, ultimately important for delirium risk assessment and prevention. The collected multimodal dataset consists of depth images, Electromyography (EMG) data, patient extremity movement captured by accelerometers, ambient light levels, Sound Pressure Level (SPL), and indoor air quality measured by volatile organic compounds, and the equivalent CO₂ concentration. For delirium risk assessment, the system recognizes mobility cues (axial body movement features and body key points) and circadian cues, including nightly disruptions, ambient SPL, and light intensity, as well as other environmental factors such as indoor air quality. The Mobi-DiQ system consists of three major components: the pervasive sensing system, a data storage and analysis server, and a data annotation system. For data collection, six local pervasive sensing systems were deployed, including a local computer and sensors. A video recording tool with graphical user interface (GUI) developed in python was used to capture depth image frames for analyzing patient mobility. All sensor data is encrypted, then automatically uploaded to the Mobi-DiQ server through a secured VPN connection. Several data pipelines are developed to automate the data transfer, curation, and data preparation for annotation and model training. The data curation and post-processing are performed on the server. A custom secure annotation tool with GUI was developed to annotate depth activity data. The annotation tool is linked to the MongoDB database to record the data annotation and to provide summarization. Docker containers are also utilized to manage services and pipelines running on the server in an isolated manner. The processed clinical data and annotations are used to train and develop real-time pervasive sensing systems to augment clinical decision-making and promote targeted interventions. In the future, we intend to evaluate our system as a clinical implementation trial, as well as to refine and validate it by using other data sources, including neurological data obtained through continuous electroencephalography (EEG).

Keywords: deep learning, delirium, healthcare, pervasive sensing

Procedia PDF Downloads 78
2422 Accessibility of Youth-Friendly Sexual and Reproductive Health Services to Secondary School Adolescents in Southern Cross River, Nigeria

Authors: Rosemary I. Eneji, Stephen Adi Odey, Edem Carole, Eucharia Nwagbara

Abstract:

Sexual and reproductive health behaviors are the main causes of death, disability, and disease among adolescents in Nigeria. In this study, we determined the accessibility of youth-friendly sexual and reproductive health services to secondary school adolescents in southern Cross River state, Nigeria. Nineteen randomly selected public secondary schools across the seven local government areas in the zone were used. The respondents were four hundred senior secondary (classes SSI - SS3) students aged 15-19 years, comprising 63.7% females and 36.3% males. A 50-item structured questionnaire was used for the study. There was a strong influence of age and sex of adolescents, income and occupation of parents, knowledge and awareness of adolescents, and tradition on the accessibility and use of youth-friendly sexual and reproductive health services (YFSRHS) to the adolescents. The attitude of health workers towards accessibility was of little effect. Overall, youth-friendly sexual and reproductive health services were not easily accessible to adolescents in the study area. Thus, there is need to enforce adolescent reproductive health policies in the area. Training and use of trained caregivers and peer educators to attend to adolescents and the inclusion of adolescent reproductive health as a subject in the curriculum are strongly recommended.

Keywords: youth, reproductive health, cross river state, secondary schools, Nigeria

Procedia PDF Downloads 50
2421 Artificial Intelligence-Based Chest X-Ray Test of COVID-19 Patients

Authors: Dhurgham Al-Karawi, Nisreen Polus, Shakir Al-Zaidi, Sabah Jassim

Abstract:

The management of COVID-19 patients based on chest imaging is emerging as an essential tool for evaluating the spread of the pandemic which has gripped the global community. It has already been used to monitor the situation of COVID-19 patients who have issues in respiratory status. There has been increase to use chest imaging for medical triage of patients who are showing moderate-severe clinical COVID-19 features, this is due to the fast dispersal of the pandemic to all continents and communities. This article demonstrates the development of machine learning techniques for the test of COVID-19 patients using Chest X-Ray (CXR) images in nearly real-time, to distinguish the COVID-19 infection with a significantly high level of accuracy. The testing performance has covered a combination of different datasets of CXR images of positive COVID-19 patients, patients with viral and bacterial infections, also, people with a clear chest. The proposed AI scheme successfully distinguishes CXR scans of COVID-19 infected patients from CXR scans of viral and bacterial based pneumonia as well as normal cases with an average accuracy of 94.43%, sensitivity 95%, and specificity 93.86%. Predicted decisions would be supported by visual evidence to help clinicians speed up the initial assessment process of new suspected cases, especially in a resource-constrained environment.

Keywords: COVID-19, chest x-ray scan, artificial intelligence, texture analysis, local binary pattern transform, Gabor filter

Procedia PDF Downloads 132
2420 Assessment of the Tectonic Effects on Soil Radon Activity along the Margin of the Arabian Plate Boundary in Northwestern Syria

Authors: Mohamed Al-Hilal

Abstract:

The main purpose of the present study is to assess the role of active tectonics in influencing the emanation level of soil radon across two tectonically active structures of the Northern Dead Sea Fault (NDSF) in northwestern Syria: namely, the Qastoon and Al-Harif fault segments. The radon measurements were basically directed by the results drawn from earlier studies of archaeoseismic and paleoseismic investigation in Al-Harif, besides integrated geophysical and morphotectonic survey at the Qastoon site. In view of that, a total of 80 soil gas radon points were measured in this work with a sampling depth of 75 cm, using the AlphaGUARD PQ 2000Pro radon detector. The background range of normal radon emission from local soil was determined in area located away from the influence of the tectonic disturbances. The obtained radon data were statistically analyzed, and the mean values have been standardized in terms of probability of magnitude, which enhances the comparison process and so facilitating the separation of normal radon variations from other anomalous or geotectonic related values. The overall results revealed remarkable occurrences of fault-associated radon anomalies with maximum peak values of ~6 to 7 times above the background, trending in accordance with the predicted traces of the fault ruptures at the Qastoon and Al-Harif, respectively.

Keywords: soil gas radon, active tectonic structure, northern dead sea fault, western Syria

Procedia PDF Downloads 164
2419 Assessment of Tourist and Community Perception with Regard to Tourism Sustainability Indicators: A Case Study of Sinharaja World Heritage Rainforest, Sri Lanka

Authors: L. P. K. Liyanage, N. R. P. Withana, A. L. Sandika

Abstract:

The purpose of this study was to determine tourist and community perception-based sustainable tourism indicators as well as Human Pressure Index (HPI) and Tourist Activity Index (TAI). Study was carried out in Sinharaja forest which is considered as one of the major eco-tourism destination in Sri Lanka. Data were gathered using a pre-tested semi-structured questionnaire as well as records from Forest department. Convenient sampling technique was applied. For the majority of issues, the responses were obtained on multi-point Likert-type scales. Visual portrayal was used for display analyzed data. The study revealed that the host community of the Kudawa gets many benefits from tourism. Also, tourism has caused negative impacts upon the environment and community. The study further revealed the need of proper waste management and involvement of local cultural events for the tourism business in the Kudawa conservation center. The TAI, which accounted to be 1.27 and monthly evolution of HPI revealed that congestion can be occurred in the Sinharaja rainforest during peak season. The results provide useful information to any party involved with tourism planning anywhere, since such attempts would be more effective once the people’s perceptions on these aspects are taken into account.

Keywords: Kudawa Conservation Center, Sinharaja World Heritage Rainforest, sustainability indicators, community perception

Procedia PDF Downloads 137
2418 Communal Shipping Container Home Design for Reducing Homelessness in Glasgow

Authors: Matthew Brady

Abstract:

Lack of affordable housing for individuals has the potential to create gaps in society, which result in thousands of people facing homelessness every year in some of the worlds most affluent cities. This paper examines strategies for providing a more economic living environment for single occupants. Focusing on comparisons of successful examples reducing homeless populations around the world, with an emphasis on social inclusion and community living. Practically exploring the architectural considerations of ensuring a suitable living environment for multiple single occupancy residents, as well as selecting the appropriate materials to ensure costs are kept to manageable level for investment from local governments. The aim of this paper is to make some practical recommendations for low cost communal living space, with particular reference to recycled shipping container homes on a potential unused site on the River Clyde in Glasgow. Ideally, the suggestions and recommendations put forward in this paper can be replicable or used for reference in other similar situations. The proposal explored in this paper is sensitive towards addressing people's standard of living and adapting homes to match may be one solution to reducing the number of people being evicted from unaffordable homes as the generally upward global trend for urbanization continues.

Keywords: affordable housing, community living, shipping container, urban regeneration

Procedia PDF Downloads 164
2417 PointNetLK-OBB: A Point Cloud Registration Algorithm with High Accuracy

Authors: Wenhao Lan, Ning Li, Qiang Tong

Abstract:

To improve the registration accuracy of a source point cloud and template point cloud when the initial relative deflection angle is too large, a PointNetLK algorithm combined with an oriented bounding box (PointNetLK-OBB) is proposed. In this algorithm, the OBB of a 3D point cloud is used to represent the macro feature of source and template point clouds. Under the guidance of the iterative closest point algorithm, the OBB of the source and template point clouds is aligned, and a mirror symmetry effect is produced between them. According to the fitting degree of the source and template point clouds, the mirror symmetry plane is detected, and the optimal rotation and translation of the source point cloud is obtained to complete the 3D point cloud registration task. To verify the effectiveness of the proposed algorithm, a comparative experiment was performed using the publicly available ModelNet40 dataset. The experimental results demonstrate that, compared with PointNetLK, PointNetLK-OBB improves the registration accuracy of the source and template point clouds when the initial relative deflection angle is too large, and the sensitivity of the initial relative position between the source point cloud and template point cloud is reduced. The primary contribution of this paper is the use of PointNetLK to avoid the non-convex problem of traditional point cloud registration and leveraging the regularity of the OBB to avoid the local optimization problem in the PointNetLK context.

Keywords: mirror symmetry, oriented bounding box, point cloud registration, PointNetLK-OBB

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2416 Antibacterial Activity of the Essential Oil of Origanum glandulosum on Bacterial Strains of Hospital Origin Most Implicated in Nosocomial Infections

Authors: A. Lardjam, R. Mazid, S. Y. Boudghene, A. Izarouken, Y. Dali, N. Djebli, H. Toumi

Abstract:

Origanum glandulosum is an aromatic plant, common in Algeria and widely used by local people for its medicinal properties. The essential oil from this plant, which grows in the west of Algeria, was studied to evaluate and determine its antibacterial activity. The extraction of the essential oil was performed by water steam distillation; the yield obtained from the aerial parts (1.78 %) is interesting, its chromatographic profile revealed by TLC showed the presence of phenolic compounds thymol and carvacrol. The evaluation of the activity of the essential oil of Origanum glandulosum on bacterial strains of hospital origin, ATCC, MRB, and HRB, most implicated in nosocomial infections (Staphylococcus aureus ATCC 25923, Staphylococcus aureus ATCC 43300, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Staphylococcus aureus resistant to meticillin, Enterococcus faecium, VA R and R TEC, Acinetobacter baumanii, IMP R and R CAZ, Klebsiella pneumonia carbapenemase-producing) by the method of aromatogramme and micro atmosphere, shows that the antibacterial potency of this oil is very high, expressed by significant inhibition diameters on all strains except Pseudomonas aeruginosa, and low MICs and is characterized by a bactericidal action.

Keywords: antibacterial activity, essential oil, HRB, MBR, nosocomial infections, origanum glandulosum

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2415 Well-being of Parents of Children with Autism Spectrum Disorder or Developmental Coordination Disorder: Cross-Cultural and Cross-disorder Comparative Studies

Authors: Léa Chawki, Émilie Cappe

Abstract:

Context: Nowadays, supporting parents of children with autism spectrum disorder (ASD) and helping them adjust to their child’s condition represents a core clinical and scientific necessity and is encouraged by the French National Strategy for Autism (2018). In France, ASD remains a challenging condition, causing distress, segregation and social stigma to concerned family members concerned by this handicap. The literature highlights that neurodevelopmental disorders in children, such as ASD, influence parental well-being. This impact could be different according to parents’ culture and the child’s particular disorder manifestation, such as developmental coordination disorder (DCC), for instance. Objectives: This present study aims to explore parental stress, anxiety and depressive symptoms, as well as the quality of life in parents of children with ASD or DCD, as well as the explicit individual, psychosocial and cultural factors of parental well-being. Methods: Participants will be recruited through diagnostic centers, child and specialized adolescent units, and organizations representing families with ASD and DCD. Our sample will include five groups of 150 parents: four groups of parents having children with ASD – one living in France, one in the US, one in Canada and the other in Lebanon – and one group of French parents of children with DCD. Self-evaluation measures will be filled directly by parents in order to measure parental stress, anxiety and depressive symptoms, quality of life, coping and emotional regulation strategies, internalized stigma, perceived social support, the child’s problem behaviors severity, as well as motor coordination deficits in children with ASD and DCD. A sociodemographic questionnaire will help collect additional useful data regarding participants and their children. Individual and semi-structured research interviews will be conducted to complete quantitative data by further exploring participants’ distinct experiences related to parenting a child with a neurodevelopmental disorder. An interview grid, specially designed for the needs of this study, will strengthen the comparison between the experiences of parents of children with ASD with those of parents of children with DCD. It will also help investigate cultural differences regarding parent support policies in the context of raising a child with ASD. Moreover, interviews will help clarify the link between certain research variables (behavioral differences between ASD and DCD, family leisure activities, family and children’s extracurricular life, etc.) and parental well-being. Research perspectives: Results of this study will provide a more holistic understanding of the roles of individual, psychosocial and cultural variables related to parental well-being. Thus, this study will help direct the implementation of support services offered to families of children with neurodevelopmental disorders (ASD and DCD). Also, the implications of this study are essential in order to guide families through changes related to public policies assisting neurodevelopmental disorders and other disabilities. The between-group comparison (ASD and DCD) is also expected to help clarify the origins of all the different challenges encountered by those families. Hence, it will be interesting to investigate whether complications perceived by parents are more likely to arise from child-symptom severity, or from the lack of support obtained from health and educational systems.

Keywords: Autism spectrum disorder, cross-cultural, cross-disorder, developmental coordination delay, well-being

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2414 Optimization of Energy Harvesting Systems for RFID Applications

Authors: P. Chambe, B. Canova, A. Balabanian, M. Pele, N. Coeur

Abstract:

To avoid battery assisted tags with limited lifetime batteries, it is proposed here to replace them by energy harvesting systems, able to feed from local environment. This would allow total independence to RFID systems, very interesting for applications where tag removal from its location is not possible. Example is here described for luggage safety in airports, and is easily extendable to similar situation in terms of operation constraints. The idea is to fix RFID tag with energy harvesting system not only to identify luggage but also to supply an embedded microcontroller with a sensor delivering luggage weight making it impossible to add or to remove anything from the luggage during transit phases. The aim is to optimize the harvested energy for such RFID applications, and to study in which limits these applications are theoretically possible. Proposed energy harvester is based on two energy sources: piezoelectricity and electromagnetic waves, so that when the luggage is moving on ground transportation to airline counters, the piezo module supplies the tag and its microcontroller, while the RF module operates during luggage transit thanks to readers located along the way. Tag location on the luggage is analyzed to get best vibrations, as well as harvester better choice for optimizing the energy supply depending on applications and the amount of energy harvested during a period of time. Effects of system parameters (RFID UHF frequencies, limit distance between the tag and the antenna necessary to harvest energy, produced voltage and voltage threshold) are discussed and working conditions for such system are delimited.

Keywords: RFID tag, energy harvesting, piezoelectric, EM waves

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2413 Preliminary Study on Milk Composition and Milk Protein Polymorphism in the Algerian Local Sheep's Breeds

Authors: A. Ameur Ameur, F. Chougrani, M. Halbouche

Abstract:

In order to characterize the sheep's milk, we analyzed and compared, in a first stage of our work, the physical and chemical characteristics in two Algerian sheep breeds: Hamra race and race Ouled Djellal breeding at the station the experimental ITELV Ain Hadjar (Saïda Province). Analyses are performed by Ekomilk Ultra-analyzer (EON TRADING LLC, USA), they focused on the pH, density, freezing, fat, total protein, solids-the total dry extract. The results obtained for these parameters showed no significant differences between the two breeds studied. The second stage of this work was the isolation and characterization of milk proteins. For this, we used the precipitation of caseins phi [pH 4.6]. For this, we used the precipitation of caseins Phi (pH 4.6). After extraction, purification and assay, both casein and serum protein fractions were then assayed by the Bradford method and controlled by polyacrylamide gel electrophoresis (PAGE) in the different conditions (native, in the presence of urea and in the presence of SDS). The electrophoretic pattern of milk samples showed the presence similarities of four major caseins variants (αs1-, αs2-β-and k-casein) and two whey proteins (β-lactoglobulin, α-lactalbumin) of two races Hamra and Ouled Djellal. But compared to bovine milk, they have helped to highlight some peculiarities as related to serum proteins (α La β Lg) as caseins, including αs1-Cn.

Keywords: Hamra, Ouled Djellal, protein polymorphism, sheep breeds

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2412 Evaluation of the Accuracy of a ‘Two Question Screening Tool’ in the Detection of Intimate Partner Violence in a Primary Healthcare Setting in South Africa

Authors: A. Saimen, E. Armstrong, C. Manitshana

Abstract:

Intimate partner violence (IPV) has been recognised as a global human rights violation. It is universally under diagnosed and the institution of timeous multi-faceted interventions has been noted to benefit IPV victims. Currently, the concept of using a screening tool to detect IPV has not been widely explored in a primary healthcare setting in South Africa, and it was for this reason that this study has been undertaken. A systematic random sampling of 1 in 8 women over a period of 3 months was conducted prospectively at the OPD of a Level 1 Hospital. Participants were asked about their experience of IPV during the past 12 months. The WAST-short, a two-question tool, was used to screen patients for IPV. To verify the result of the screening, women were also asked the remaining questions from the WAST. Data was collected from 400 participants, with a response rate of 99.3%. The prevalence of IPV in the sample was 32%. The WAST-short was shown to have the following operating characteristics: sensitivity 45.2%, specificity 98%,positive predictive value 98%, negative predictive value 79%. The WAST-short lacks sufficient sensitivity and therefore is not an ideal screening tool for this setting. Improvement in the sensitivity of the WAST-short in this setting may be achieved by lowering the threshold for a positive result for IPV screening, and modification of the screening questions to better reflect IPV as understood by the local population.

Keywords: domestic violence, intimate partner violence, screening, screening tools

Procedia PDF Downloads 291
2411 Comparative Study of Outcome of Patients with Wilms Tumor Treated with Upfront Chemotherapy and Upfront Surgery in Alexandria University Hospitals

Authors: Golson Mohamed, Yasmine Gamasy, Khaled EL-Khatib, Anas Al-Natour, Shady Fadel, Haytham Rashwan, Haytham Badawy, Nadia Farghaly

Abstract:

Introduction: Wilm's tumor is the most common malignant renal tumor in children. Much progress has been made in the management of patients with this malignancy over the last 3 decades. Today treatments are based on several trials and studies conducted by the International Society of Pediatric Oncology (SIOP) in Europe and National Wilm's Tumor Study Group (NWTS) in the USA. It is necessary for us to understand why do we follow either of the protocols, NWTS which follows the upfront surgery principle or the SIOP which follows the upfront chemotherapy principle in all stages of the disease. Objective: The aim of is to assess outcome in patients treated with preoperative chemotherapy and patients treated with upfront surgery to compare their effect on overall survival. Study design: to decide which protocol to follow, study was carried out on records for patients aged 1 day to 18 years old suffering from Wilm's tumor who were admitted to Alexandria University Hospital, pediatric oncology, pediatric urology and pediatric surgery departments, with a retrospective survey records from 2010 to 2015, Design and editing of the transfer sheet with a (PRISMA flow study) Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data were fed to the computer and analyzed using IBM SPSS software package version 20.0. (11) Qualitative data were described using number and percent. Quantitative data were described using Range (minimum and maximum), mean, standard deviation and median. Comparison between different groups regarding categorical variables was tested using Chi-square test. When more than 20% of the cells have expected count less than 5, correction for chi-square was conducted using Fisher’s Exact test or Monte Carlo correction. The distributions of quantitative variables were tested for normality using Kolmogorov-Smirnov test, Shapiro-Wilk test, and D'Agstino test, if it reveals normal data distribution, parametric tests were applied. If the data were abnormally distributed, non-parametric tests were used. For normally distributed data, a comparison between two independent populations was done using independent t-test. For abnormally distributed data, comparison between two independent populations was done using Mann-Whitney test. Significance of the obtained results was judged at the 5% level. Results: A significantly statistical difference was observed for survival between the two studied groups favoring the upfront chemotherapy(86.4%)as compared to the upfront surgery group (59.3%) where P=0.009. As regard complication, 20 cases (74.1%) out of 27 were complicated in the group of patients treated with upfront surgery. Meanwhile, 30 cases (68.2%) out of 44 had complications in patients treated with upfront chemotherapy. Also, the incidence of intraoperative complication (rupture) was less in upfront chemotherapy group as compared to upfront surgery group. Conclusion: Upfront chemotherapy has superiority over upfront surgery.As the patient who started with upfront chemotherapy shown, higher survival rate, less percent in complication, less percent needed for radiotherapy, and less rate in recurrence.

Keywords: Wilm's tumor, renal tumor, chemotherapy, surgery

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2410 Financial Risk Tolerance and Its Impact on Terrorism-Tourism Relation in Pakistan

Authors: Sania Sana, Afnan Nasim, Usman Malik, Maroof Tahir

Abstract:

The aim of this research is to scrutinize the interdependent relationship between terrorism and behavioral changes in the tourism activities in Pakistan with the moderating impact of a unique variable titled 'Financial Risk Tolerance'. The article looks at the inter-reliant relationship with the alleged political and economic aspects and behavioral changes in the tourists and the consumers by these variables over time. The researchers used many underlying theories like the catastrophe theory by (Svyantek, Deshon and Siler 1991), information integration theory (Anderson 1981, 1982) and prospect theory (Kahneman and Tversky 1979) to shape the study’s framework as per tourist decision making model. A sample of around 110 locals was used for this purpose and the data was gathered by convenience sampling. The responses were analyzed using regression analysis. The results exhibited how terrorism along with the influence of financial risk tolerance had inclined a behavioral shift in the travelling patterns and vacation destination choice of the local tourists. Lastly, the paper proposes a number of suggestive measures for the tourism industry and the legislative bodies to ensure the safety of travelers and to boost the tourist activities in the vacation industry of Pakistan.

Keywords: terrorism, tourism, financial risk tolerance, tourist decision-making, destination choice

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2409 Identifying the Strength of Cyclones and Earthquakes Requiring Military Disaster Response

Authors: Chad A. Long

Abstract:

The United States military is now commonly responding to complex humanitarian emergencies and natural disasters around the world. From catastrophic earthquakes in Haiti to typhoons devastating the Philippines, U.S. military assistance is requested when the event exceeds the local government's ability to assist the population. This study assesses the characteristics of catastrophes that surpass a nation’s individual ability to respond and recover from the event. The paper begins with a historical summary of military aid and then analyzes over 40 years of the United States military humanitarian response. Over 300 military operations were reviewed and coded based on the nature of the disaster. This in-depth study reviewed the U.S. military’s deployment events for cyclones and earthquakes to determine the strength of the natural disaster requiring external assistance. The climatological data for cyclone landfall and magnitude data for earthquake epicenters were identified, grouped into regions and analyzed for time-based trends. The results showed that foreign countries will likely request the U.S. military for cyclones with speeds greater or equal to 125 miles an hour and earthquakes at the magnitude of 7.4 or higher. These results of this study will assist the geographic combatant commands in determining future military response requirements.

Keywords: military, natural disasters, earthquakes, cyclone

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2408 Cystic Ganglionosis in Child: Rare Entity

Authors: Jatinder Pal Singh, Harpreet Singh, Gagandeep Singh Digra, Mandeep Kaur Sidhu, Pawan Kumar

Abstract:

Introduction: Ganglion cyst is a benign condition in which there is a cystic lesion in relation to a joint or a tendon sheath arising from myxoid degeneration of fibrous connective tissue. These can be unilocular or multilocular. In rare cases, there may be multiple ganglion cysts, known as cystic ganglionosis. They can occur at any age but are commonly seen in adults. Clinically they may be asymptomatic or present as swelling or mass effect in adjacent structures. These are common in extremities such as hands and feet. Case Presentation: 11-year-old female child presented with slowly progressive painless swelling of her right hand since the age of 4. Antenatal and perinatal history was unremarkable. Her family history was negative. She denies fever, malaise, morning stiffness, weight loss, fatigue, restriction of joint movements, or any sensory and motor deficit. Lab parameters were negative for inflammatory or infectious etiology. No other joint or extremity involvement was present. On physical examination, the swelling was present on the dorsum and palmer aspect of the right hand and wrist. They were non-tender on palpation without any motor or sensory deficit. MRI hand revealed multiple well-defined fluid signal intensity cystic appearing lesions in periarticular/intraarticular locations in relation to distal radio-ulnar, radio-carpal, intercarpal, carpometacarpal, metacarpophalangeal and interphalangeal joints as well as peritendinous location around flexor tendons more so in the region of wrist, palm, 1st and 5th digit and along extensor tendons in the region of wrist, largest one noted along flexor pollicis longus tendon in thenar region and along 1st digit measuring approx. 4.6 x 1.2 x 1.2 centimeter. Pressure erosions and bone remodelling were noted in the bases of the 2nd to 5th metacarpals, capitate, trapezoid, the distal shaft of 1st metacarpal, and proximal phalanx of 1st digit. Marrow edema was noted in the base and proximal shaft of the 4th metacarpal and proximal shaft of the 3rd metacarpal – likely stress or pressure related. The patient was advised of aspiration, but the family refused the procedure. Therefore the patient was kept on conservative treatment. Conclusion: Cystic ganglionosis is a rare condition with very few cases reported in the medical literature. Its prevalence and association are not known because of the rarity of this condition. It should be considered as an important differential in patients presenting with soft tissue swelling in extremities. Treatment option includes conservative management, aspiration, and surgery. Aspiration has a high recurrence rate. Although surgery has a low recurrence rate, it carries a high rate of complications. Imaging with MRI is essential for confirmation of the cystic nature of lesions and their relation with the joint capsules or tendons. This helps in differentiating from other soft tissue lesions and presurgical planning.

Keywords: radiology, rare, cystic ganglionosis, child

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2407 Thailand’s Education Cooperation with Neighboring Countries: The Key Factors to Strengthen the “Soft Power” Relationship

Authors: Rungrot Trongsakul

Abstract:

This paper was aimed to study the model of education cooperation during Thailand and neighbor countries, especially the countries which the territory-cohesion border with Thailand used “Soft Power” to enhance the good relationship. This research employed qualitative method, analyzed and synthesized the content of cooperation projects, policies, laws, relevant theories, relevant research papers and documents and used SWOT analysis. The research findings revealed that Thailand’s education cooperation projects with neighbor countries had two characteristics: 1) education cooperation projects/programs were a part in economic cooperation projects, and 2) there were directly education cooperation projects. The suggested education cooperation model was based on the concept of “Soft Power”, thus the determination of action plans or projects as key factors of public and private organizations should be based on sincere participation among people, communities and relevant organizations of the neighbor countries. Adoption of education-cultural exchange, learning and sharing process is a key to strengthen good relationship of the countries’ cooperation. The roles of education in this included sharing and acceptance of culture and local wisdom, human resource development, knowledge management, integration and networking building could enhance relationship between agents of related organizations of Thailand and neighbors countries.

Keywords: education, soft-power, relationship, cooperation, Thailand neighboring countries

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2406 Tourism as Economic Resource for Protecting the Landscape: Introducing Touristic Initiatives in Coastal Protected Areas of Albania

Authors: Enrico Porfido

Abstract:

The paper aims to investigate the relation between landscape and tourism, with a special focus on coastal protected areas of Albania. The relationship between tourism and landscape is bijective: There is no tourism without landscape attractive features and on the other side landscape needs economic resources to be conserved and protected. The survival of each component is strictly related to the other one. Today, the Albanian protected areas appear as isolated islands, too far away from each other to build an efficient network and to avoid waste in terms of energy, economy and working force. This study wants to stress out the importance of cooperation in terms of common strategies and the necessity of introducing a touristic sustainable model in Albania. Comparing the protection system laws of the neighbor countries of the Adriatic-Ionian region and through a desk review on the best practices of protected areas that benefit from touristic activities, the study proposes the creation of the Albanian Riviera Landscape Park. This action will impact positively the whole southern Albania territory, introducing a sustainable tourism network that aims to valorize the local heritage and to stop the coastal exploitation processes. The main output is the definition of future development scenarios in Albania with the establishment of new protected areas and the introduction of touristic initiatives.

Keywords: Adriatic-Ionian region, protected areas, tourism for landscape, sustainable tourism

Procedia PDF Downloads 264
2405 Effect of the Average Kits Birth Weight and of the Number of Born Alive per Liter on the Milk Production of Algerian Rabbit Raised in Aures Area

Authors: S. Moumen, M. Melizi

Abstract:

In order to characterize rabbits does of an Aures local population raised in Algeria; a study of their milk yield was realized in the experimental rabbitry of El Hadj Lakhdhar University. Milk production of does was measured every day during the days following 215 parturitions. It was estimated by weighing the female before and after the single daily suckling (10-15 min between the 2 weighing operations). The various calculated parameters were the quantity of milk produced per day, per week and the total quantity produced in 21 days, as well as the intake of milk by young rabbits. The analysis concerned the effects of the number of successive litters (3 classes: 1 to 3 and more) and of the average number of the number of young rabbits suckled per litter (6 classes: from 1-2 kits to more than 6). During the 21 days of controlled lactation, the average litter size was 6±3. The rabbits of the Aures area produced on average 2544.34±747 g in 21 days that is 121 g of milk/day or 21g of milk/kit/day. The milk yield increased from 526, 1035, 1240, and 2801g to 760, 1365, 1715 and 3840 for week 1, 2, 3 and the total period of lactation respectively. Nevertheless, milk production available per kit and per day decreased linearly with kits number in the litter for each of the 3 weeks considered. On the other hand the milk yield was not affected by the weight at birth of kits.

Keywords: milk production, litter size, rabbit, Aures area, Algeria

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2404 Ab Initio Study of Co2ZrGe and Co2NbB Full Heusler Compounds

Authors: A. Abada, S. Hiadsi, T. Ouahrani, B. Amrani, K. Amara

Abstract:

Using the first-principles full-potential linearized augmented plane wave plus local orbital (FP-LAPW+lo) method based on density functional theory (DFT), we have investigated the electronic structure and magnetism of some Co2- based full Heusler alloys, namely Co2ZrGe and Co2NbB. The calculations show that these compounds are to be half-metallic ferromagnets (HMFs) with a total magnetic moment of 2.000 µB per formula unit, well consistent with the Slater-Pauling rule. Our calculations show indirect band gaps of 0.58 eV and 0.47 eV in the minority spin channel of density of states (DOS) for Co2ZrGe and Co2NbB, respectively. Analysis of the DOS and magnetic moments indicates that their magnetism is mainly related to the d-d hybridization between the Co and Zr (or Nb) atoms. The half metallicity is found to be robust against volume changes and the two alloys kept a 100% of spin polarization at the Fermi level. In addition, an atom inside molecule AIM formalism and an electron localization function ELF were also adopted to study the bonding properties of these compounds, building a bridge between their electronic and bonding behavior. As they have a good crystallographic compatibility with the lattice of semiconductors used industrially and negative calculated cohesive energies with considerable absolute values these two alloys could be promising magnetic materials in the spintronics field.

Keywords: half-metallic ferromagnets, full Heusler alloys, magnetic properties, electronic properties

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2403 Harmful Algal Blooms in Omani and Arabian Sea and Their Effect on Marine Environment

Authors: Hamed Mohammed Al Gheilani

Abstract:

Red tide, one of the harmful algal blooms (HABs) is a natural ecological phenomenon and often this event is accompanied by severe impacts on coastal resources, local economies, and public health. The occurrence of red tides has become more frequent in Omani waters in recent years. Some of them caused fish kill, damaged fishery resources and mariculture, threatened the marine environment and the osmosis membranes of desalination plants. However, a number of them have been harmless. The most common dinoflagellate Noctiluca scintillans is associated with the red tide events in Omani waters. Toxic species like Karenia selliformis, Prorocentrum arabianum, and Trichodesmium erythraeum have also been reported recently. Although red tides in Oman have been considered a consequence of upwelling in the summer season (May to September), recent phytoplankton outbreaks in Oman are not restricted to summer. Frequent algal blooms have been reported during winter (December to March). HABs may have contributed to hypoxia and/or other negative ecological impacts. The effects of HABs on desalination plan were increased in last three years, by blooms of Cochlodinium, noctiluca species, and blooms of jellyfish. Most of these blooms were affected Al Batinah and Muscat coast. These effects include millions of Omani Rials and several shutdowns of desalination plans during these years.

Keywords: red tide, environment, hypoxia, noctiluca

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2402 A Randomized Controlled Trial Study on the Effect of Adding Dexmedetomidine to Bupivacaine in Supraclavicular Block Using Ultrasound Guidance

Authors: Nazia Nazir

Abstract:

Background: The benefits of regional anesthetic techniques are well established. Use of additives to local anesthetics can prolong these benefits. The aim of this study was to observe the effect of adding dexmedetomidine to bupivacaine for the supraclavicular block. Methods (Design): In this randomized, double-blind study, seventy ASA I & II patients of either sex undergoing elective surgeries on the upper limb were given supraclavicular block under ultrasound guidance. Group C (n=35), received 38 mL 0.25% bupivacaine + 2mL normal saline and group D received 38 mL 0.25% bupivacaine + 1 µg/kg dexmedetomidine (2mL). Patients were observed for onset, duration of motor and sensory block, duration of analgesia, sedation score, hemodynamic changes and any adverse events. Results: In group D the onset was faster (P < 0.001), duration of sensory and motor block, as well as duration of analgesia, was prolonged as compared to group C (P < 0.0001). There was significant drop in heart rate (HR) from the baseline in group D (P < 0.05) at 30, 60, 90 and 120 min, however, none of the patients dropped HR below 50/min. Mean arterial Pressure (MAP) remained unaffected. The patients in group D were effectively sedated than those in group C (P < 0.05). No adverse event was reported in either group. Conclusion: Dexmedetomidine as adjuvant to bupivacaine in supraclavicular block resulted in faster action, prolonged motor and sensory block, prolonged analgesia with hemodynamic stability and adequate sedation.

Keywords: Analgesia, bupivacaine, dexmedetomidine, supraclavicular block

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2401 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

Procedia PDF Downloads 142