Search results for: combined fatigue

Authors: Mohammed M. Mahdy Tawfeek

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Objective: The aim of this work is to compare the outcome of photoactivated chromophore for keratitis-cross linking (PACK-CXL) window absorption (WA) alone with combined PACK-CXL WA and standard anti-microbial therapy (SAT) for the treatment of infectious keratitis. Patients and Methods: This is a randomized prospective comparative clinical trial. Thirty eyes with clinically suspected infectious keratitis were randomly assigned into two equal groups of 15 eyes each: Group (A) was treated by PACK-CXL WA alone and group (B) was treated by PACK-CXL WA combined with SAT. Identification of organisms was made by lab study before treatment. Corneal healing was evaluated by corneal examination and anterior segment OCT (AS-OCT). Written informed consent was obtained from all participants and the study was approved by the research ethics committee of the Faculty of Medicine, Zagazig University. The work has been carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki) for studies involving humans. Results: Complete healing and resolution (Successful treatment) were observed in 10 eyes (66.7%) of a group (A) and 14 eyes (93.3%) of group (B) and failure was observed in 5 eyes (33.3%) of a group (A) and one eye (6.67%) of group (B). They were statistically significant (P =0.042 and 0.003) in a comparison between both groups regarding success and failure of treatment, respectively. Complete corneal healing was reported in the third month postoperatively in 10 eyes (66.7%) of group (A) and 14 eyes (93.3%) of group (B). Complications were absent in 12 patients (80%) in group (A) and 14 patients (93.3%) of group (B); however, perforation and impending perforation were found in 3 patients of group (A) and only one patient of group (B). Conclusion: PACK-CXL is a promising, non-invasive treatment option for infectious keratitis, especially when performed with the window absorption (WA) technique, either alone or combined with SAT. It has a synergistic effect with a standard antimicrobial treatment that gives good outcome results in the treatment of infectious keratitis. Also, it avoids the antibiotics resistance that has become rapidly spreading worldwide.

Keywords: corneal cross linking, infectious keratitis, PACK-CXL, window absorption

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Authors: Sarah Crawford, Gerry Lesley

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This research is a pre-clinical assessment of anti-cancer effects of novel non-steroidal diethyl stilbestrol-like estrogen analogs in estrogen-receptor positive/ progesterone-receptor positive human breast cancer microtumors of MCF 7 cell line. Tamoxifen analog formulation (Tam A1) was used as a single agent or in combination with therapeutic concentrations of 4-hydroxytamoxifen, currently used as a long-term treatment for the prevention of breast cancer recurrence in women with estrogen receptor positive/ progesterone receptor positive malignancies. At concentrations ranging from 30-50 microM, Tam A1 induced microtumor disaggregation and cell death. Incremental cytotoxic effects correlated with increasing concentrations of Tam A1. Live tumor microscopy showed that microtumos displayed diffuse borders and substrate-attached cells were rounded-up and poorly adherent. A complete cytotoxic effect was observed using 40-50 microM Tam A1 with time course kinetics similar to 4-hydroxytamoxifen. Combined treatment with TamA1 (30-50 microM) and 4-hydroxytamoxifen (10-15 microM) induced a highly cytotoxic, synergistic combined treatment response that was more rapid and complete than using 4-hydroxytamoxifen as a single agent therapeutic. Microtumors completely dispersed or formed necrotic foci indicating a highly cytotoxic combined treatment response. Moreover, breast cancer microtumors treated with both 4-hydroxytamoxifen and Tam A1 displayed lower levels of long-term post-treatment regrowth, a critical parameter of primary drug resistance, than observed for 4-hydroxytamoxifen when used as a single agent therapeutic. Tumor regrowth at 6 weeks post-treatment with either single agent 4-hydroxy tamoxifen, Tam A1 or a combined treatment was assessed for the development of drug resistance. Breast cancer cells treated with both 4-hydroxytamoxifen and Tam A1 displayed significantly lower levels of post-treatment regrowth, indicative of decreased drug resistance, than observed for either single treatment modality. The preclinical data suggest that combined treatment involving the use of tamoxifen analogs may be a novel clinical approach for long-term maintenance therapy in patients with estrogen-receptor positive/progesterone-receptor positive breast cancer receiving hormonal therapy to prevent disease recurrence. Detailed data on time-course, IC50 and tumor regrowth assays post- treatment as well as a proposed mechanism of action to account for observed synergistic drug effects will be presented.

Keywords: 4-hydroxytamoxifen, tamoxifen analog, drug-resistance, microtumors

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Authors: Aderet M. Pantierer, Shmuel Pantierer, Raphael Cordina, Yougashwar Budhoo

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Stress concentration occurs when there is an abrupt change in geometry, a mechanical part under loading. These changes in geometry can include holes, notches, or cracks within the component. The modifications create larger stress within the part. This maximum stress is difficult to determine, as it is directly at the point of the minimum area. Strain gauges have yet to be developed to analyze stresses at such minute areas. Therefore, a stress concentration factor must be utilized. The stress concentration factor is a dimensionless parameter calculated solely on the geometry of a part. The factor is multiplied by the nominal, or average, stress of the component, which can be found analytically or experimentally. Stress concentration graphs exist for common loading conditions and geometrical configurations to aid in the determination of the maximum stress a part can withstand. These graphs were developed from historical data yielded from experimentation. This project seeks to verify a stress concentration graph for combined loading conditions. The aforementioned graph was developed using CATIA Finite Element Analysis software. The results of this analysis will be validated through further testing. The 3D modeled parts will be subjected to further finite element analysis using Patran-Nastran software. The finite element models will then be verified by testing physical specimen using a tensile testing machine. Once the data is validated, the unique stress concentration graph will be submitted for publication so it can aid engineers in future projects.

Keywords: stress concentration, finite element analysis, finite element models, combined loading

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Authors: Lana Burmistrova

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Introduction: The influence of visual impairments on several cognitive processes used in the music learning process is an increasingly important area in special education and cognitive musicology. Many children have several visual impairments due to the refractive errors and irreversible inhibitors. However, based on the compensatory neuroplasticity and functional reorganization, congenitally blind (CB) and early blind (EB) individuals use several areas of the occipital lobe to perceive and process auditory and tactile information. CB individuals have greater memory capacity, memory reliability, and less false memory mechanisms are used while executing several tasks, they have better working memory (WM) and short-term memory (STM). Blind individuals use several strategies while executing tactile and working memory n-back tasks: verbalization strategy (mental recall), tactile strategy (tactile recall) and combined strategies. Methods and design: The aim of the pilot study was to substantiate similar tendencies while executing attention, memory and combined auditory tasks in blind and sighted individuals constructed for this study, and to investigate attention, memory and combined mechanisms used in the music learning process. For this study eight (n=8) blind and eight (n=8) sighted individuals aged 13-20 were chosen. All respondents had more than five years music performance and music learning experience. In the attention task, all respondents had to identify pitch changes in tonal and randomized melodic pairs. The memory task was based on the mismatch negativity (MMN) proportion theory: 80 percent standard (not changed) and 20 percent deviant (changed) stimuli (sequences). Every sequence was named (na-na, ra-ra, za-za) and several items (pencil, spoon, tealight) were assigned for each sequence. Respondents had to recall the sequences, to associate them with the item and to detect possible changes. While executing the combined task, all respondents had to focus attention on the pitch changes and had to detect and describe these during the recall. Results and conclusion: The results support specific features in CB and EB, and similarities between late blind (LB) and sighted individuals. While executing attention and memory tasks, it was possible to observe the tendency in CB and EB by using more precise execution tactics and usage of more advanced periodic memory, while focusing on auditory and tactile stimuli. While executing memory and combined tasks, CB and EB individuals used passive working memory to recall standard sequences, active working memory to recall deviant sequences and combined strategies. Based on the observation results, assessment of blind respondents and recording specifics, following attention and memory correlations were identified: reflective attention and STM, reflective attention and periodic memory, auditory attention and WM, tactile attention and WM, auditory tactile attention and STM. The results and the summary of findings highlight the attention and memory features used in the music learning process in the context of blindness, and the tendency of the several attention and memory types correlated based on the task, strategy and individual features.

Keywords: attention, blindness, memory, music learning, strategy

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Authors: Fawibe O. O., Mustafa A. A., Oyelakin A. S., Dada O. A., Ojo E. S.

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Field experiment was carried out during the cropping season of 2021 to examine the influence of the sole or combined application of rice-straw biochar and poultry manure on yield, nutrient uptake, and physiological attributes of Capsicum frutescens. The experiment was a randomized complete block design with five replicates. Treatments were 10 t/ha biochar (BC), 5 t/ha biochar + 5 t/ha poultry manure (BC+PM), 10 t/ha poultry manure (PM), and no amendment as the control (NA ). Parameters determined were fruit yield, aboveground biomass, macro and micro nutrients in leaves, antinutrients content, and pigments (chlorophyll a, chlorophyll b, and carotenoids) concentration. Data were analysed with one-way analysis of variance, while means were separated using Duncan’s Multiple Range Test at p<0.05. Soil amended with PM increased the nitrogen content of C. frutescens leaves by 40.9%, while polyphenol and phytic acid were reduced by 20.5% and 29.2%, respectively, compared with NA. Moreover, PM increased chlorophyll a and chlorophyll b by 91.9% and 16.4%, whereas proline was reduced by 31.3% compared with NA. However, PM and BC+PM had comparable influence on pigments, nutrients and antinutrients contents of C. frutescens. BC+PM significantly increased yield and aboveground biomass of C. frutescens by 52.9% and 99.2%, respectively, compared with NA. BC had no significant influence on the yield and nutrient uptake of C. frutescens compared with NA. In conclusion, sole application of poultry manure or combined with rice-straw biochar increased yield and nutrients availability in the leaves of C. frutescens.

Keywords: capsicum frutescens, biochar, nutrient uptake, poultry manure, organic amendment

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Authors: Gaurav D. Sonawane, Vikas G. Sargade

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The present investigation is a study of the effect of advanced Physical Vapor Deposition (PVD) coatings on cutting temperature residual stresses and surface roughness during Duplex Stainless Steel (DSS) 2205 turning. Austenite stabilizers like nickel, manganese, and molybdenum reduced the cost of DSS. Surface Integrity (SI) plays an important role in determining corrosion resistance and fatigue life. Resistance to various types of corrosion makes DSS suitable for applications with critical environments like Heat exchangers, Desalination plants, Seawater pipes and Marine components. However, lower thermal conductivity, poor chip control and non-uniform tool wear make DSS very difficult to machine. Cemented carbide tools (M grade) were used to turn DSS in a dry environment. AlTiN and AlTiCrN coatings were deposited using advanced PVD High Pulse Impulse Magnetron Sputtering (HiPIMS) technique. Experiments were conducted with cutting speed of 100 m/min, 140 m/min and 180 m/min. A constant feed and depth of cut of 0.18 mm/rev and 0.8 mm were used, respectively. AlTiCrN coated tools followed by AlTiN coated tools outperformed uncoated tools due to properties like lower thermal conductivity, higher adhesion strength and hardness. Residual stresses were found to be compressive for all the tools used for dry turning, increasing the fatigue life of the machined component. Higher cutting temperatures were observed for coated tools due to its lower thermal conductivity, which results in very less tool wear than uncoated tools. Surface roughness with uncoated tools was found to be three times higher than coated tools due to lower coefficient of friction of coating used.

Keywords: cutting temperature, DSS2205, dry turning, HiPIMS, surface integrity

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Authors: Cory Cannon

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In the current era of shrinking budgets, increasing amounts of worldwide natural disasters, state and non-state initiated conflicts within the world. The response has involved multinational coalitions to conduct effective military operations. The need for a Knowledge Management strategy when developing these coalitions have been overlooked in the past and the need for developing these accords early on will save time and help shape the way information and knowledge are transferred from the staff and action officers of the coalition to the decision-makers in order to make timely decisions within an ever changing environment. The aim of this paper is to show how Knowledge Management has developed within the United States military and how the transformation of working within a Combined/ Joint environment in both the Middle East and the Far East has improved relations between members of the coalitions as well as being more effective as a military force. These same principles could be applied to multinational corporations when dealing with cultures and decision-making processes.

Keywords: civil-military, culture, joint environment, knowledge management

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Authors: Gholamhossein Hosseini

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Two earliness cotton genotypes I and II, which had been developed by hybridization and backcross methods between sindise-80 as an early maturing gene parent and two other lines i.e. Red leaf and Bulgare-557 as a second parent, are subjected to different environmental conditions. The early maturing genotypes with coded names of I and II were compared with four native cotton cultivars in randomized complete block design (RCBD) with four replications in three ecological regions of Iran from 2016-2017. Two early maturing genotypes along with four native cultivars viz. Varamin, Oltan, Sahel and Arya were planted in Agricultural Research Station of Varamin, Moghan and Kashmar for evaluation. Earliness data were collected for six treatments during two years in the three regions except missing data for the second year of Kashmar. Therefore, missed data were estimated and imputed. For testing the homogeneity of error variances, each experiment at a given location or year is analyzed separately using Hartley and Bartlett’s Chi-square tests and both tests confirmed homogeneity of variance. Combined analysis of variance showed that genotypes I and II were superior in Varamin, Moghan and Kashmar regions. Earliness means and their interaction effects were compared with Duncan’s multiple range tests. Finally combined analysis of variance showed that genotypes I and II were superior in Varamin, Moghan and Kashmar regions. Earliness means and their interaction effects are compared with Duncan’s multiple range tests.

Keywords: cotton, combined, analysis, earliness

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Authors: Engy Adel Mohamed, Yasser Gamal-Eldin Hegazy

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This paper presents a firefly based algorithm for optimal sizing and allocation of distributed generators for profit maximization. Distributed generators in the proposed algorithm are of photovoltaic and combined heat and power technologies. Combined heat and power distributed generators are modeled as voltage controlled nodes while photovoltaic distributed generators are modeled as constant power nodes. The proposed algorithm is implemented in MATLAB environment and tested the unbalanced IEEE 37-node feeder. The results show the effectiveness of the proposed algorithm in optimal selection of distributed generators size and site in order to maximize the total system profit.

Keywords: distributed generators, firefly algorithm, IEEE 37-node feeder, profit maximization

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Authors: Annesha Ghosh, S. B. Agrawal

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Agricultural sector is facing a serious threat due to climate change and exacerbation of different atmospheric pollutants. Tropospheric ozone (O₃) is considered as a dynamic air pollutant imposing substantial phytotoxicity to natural vegetations and agriculture worldwide. Naturally, plants are exposed to different environmental factors and their interactions. Amongst such interactions, studies related to O₃ and water stress are still rare. In the present experiment, wheat cultivar HD2967 were grown in open top chambers (OTC) under two O₃ concentration; ambient O₃ level (A) and elevated O₃ (E) (ambient + 20 ppb O₃) along with two different water supply; well-watered (W) and 50% water stress conditions (WS), with an aim to assess the individual and interactive effect of two most prevailing stress factors in Indo-Gangetic Plains of India. Exposure to elevated O₃ dose caused early senescence symptoms and reduction in growth and biomass of the test cultivar. The adversity was more pronounced under the combined effect of EWS. Significant reduction of stomatal conductance (gs) and assimilation rate were observed under combined stress condition compared to the control (AW). However, plants grown under individual stress conditions displayed higher gs, biomass, and antioxidant defense mechanism compared to the plants grown under the presence of combined stresses. Higher induction in most of the enzyme activities of catalase (CAT), ascorbate peroxidase (APX), glutathione reductase (GR), peroxidase (POD) and superoxide dismutase (SOD) was displayed by HD 2967 under EW while, under the presence of combined stresses (EWS), a moderate increment of APX and CAT activity was observed only at its vegetative phase. Furthermore, variations in nutrient uptake and redistribution to different plants parts were also observed in the present study. Reduction in water availability has checked nutrient uptake (N, K, P, Ca, Cu, Mg, Zn) in above-ground parts (leaf) and below-ground parts (root). On the other hand, carbon (C) accumulation with subsequent C-N ratio was observed to be higher in the leaves under EWS. Such major nutrient check and limitation in carbon fixation due to lower gs under combined stress conditions might have weakened the defense mechanisms of the test cultivar. Grain yield was significantly reduced under EWS followed by AWS and EW as compared to their control, exhibiting an additive effect on the grain yield.

Keywords: antioxidants, open-top chambers, ozone, water stress, wheat, yield

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Authors: Marwa I. Shabayek, Ola A. Said, Hanan A. Attaia, Heba A. Awida

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Bladder carcinoma is an important worldwide health problem. Both cystoscopy and urine cytology used in detecting bladder cancer suffer from drawbacks where cystoscopy is an invasive method and urine cytology shows low sensitivity in low grade tumors. This study validates easier and less time-consuming techniques to evaluate the value of combined use of angiogenin and clusterin in comparison and combination with voided urine cytology in the detection of bladder cancer patients. This study includes malignant (bladder cancer patients, n= 50), benign (n=20), and healthy (n=20) groups. The studied groups were subjected to cystoscopic examination, detection of bilharzial antibodies, urine cytology, and estimation of urinary angiogenin and clusterin by ELISA. The overall sensitivity and specifcity were 66% and 75% for angiogenin, 70% and 82.5% for clusterin and 46% and 80% for voided urine cytology. Combined sensitivity of angiogenin and clusterin with urine cytology increased from 82 to 88%.

Keywords: angiogenin, bladder cancer, clusterin, cytology

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Authors: Desta Brhanu Gebrehiwot

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The purpose of this review was to analyze the overall or combined effect of scholarly studies conducted on the impacts of Food for work (FFW) and Productive Safety Net Program (PSNP) on farm households’ livelihood (agricultural investment on the adoption of fertilizer, food security, livestock holding, nutrition and its’ disincentive effect) in Ethiopia. In addition, to make a critical assessment of the internal and external validity of the existing studies, the review also indicates the possibility to redesign the program. The method of selecting eligible studies for review was PICOS (Participants, Intervention, Comparison, Outcomes, and Settings) framework. The method of analysis was the fixed effects model under Meta-Analysis. The findings of this systematic review confirm the overall or combined positive significant impact of PSNP on fertilizer adoption (combined point estimate=0.015, standard error=0.005, variance=0.000, lower limit 0.004 up to the upper limit=0.026, z-value=2.726, and p-value=0.006). And the program had a significant positive impact on the child nutrition of rural households and had no significant disincentive effect. However, the program had no significant impact on livestock holdings. Thus, PSNP is important for households whose livelihood depends on rain-fed agriculture and are exposed to rainfall shocks. Thus, better to integrate the program into the national agricultural policy. In addition, most of the studies suggested that PSNP needs more attention to the design and targeting issued in order to be effective and efficient in social protection.

Keywords: meta-analysis, fixed effect model, PSNP, rural-livelihood, Ethiopia

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Authors: Salman Obaidoon, Mohamed Hassan, Omer Bakather

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As environmental regulations increase, the need for a clean and inexpensive energy is becoming necessary these days using an available raw material with high efficiency and low emissions of toxic gases. This paper presents a study on modifying a gas turbine power plant fired by diesel, which is located in Saudi Arabia in order to increase the efficiency and capacity of the station as well as decrease the rate of emissions. The studied power plant consists of 30 units with different capacities and total net power is 1470 MW. The study was conducted on unit number 25 (GT-25) which produces 72.3 MW with 29.5% efficiency. In the beginning, the unit was modeled and simulated by using WinSim Design II software. In this step, actual unit data were used in order to test the validity of the model. The net power and efficiency obtained from software were 76.4 MW and 32.2% respectively. A difference of about 6% was found in the simulated power plant compared to the actual station which means that the model is valid. After the validation of the model, the simple gas turbine power plant was converted to a combined cycle power plant (CCPP). In this case, the exhausted gas released from the gas turbine was introduced to a heat recovery steam generator (HRSG), which consists of three heat exchangers: an economizer, an evaporator and a superheater. In this proposed model, many scenarios were conducted in order to get the optimal operating conditions. The net power of CCPP was increased to 116.4 MW while the overall efficiency of the unit was reached to 49.02%, consuming the same amount of fuel for the gas turbine power plant. For the purpose of comparing the rate of emissions of carbon dioxide on each model. It was found that the rate of CO₂ emissions was decreased from 15.94 kg/s to 9.22 kg/s by using the combined cycle power model as a result of reducing of the amount of diesel from 5.08 kg/s to 2.94 kg/s needed to produce 76.5 MW. The results indicate that the rate of emissions of carbon dioxide was decreased by 42.133% in CCPP compared to the simple gas turbine power plant.

Keywords: combined cycle power plant, efficiency, heat recovery steam generator, simulation, validation, WinSim design II software

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Authors: John R Evans, Sook-Ying Ho, Rey Chin

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This paper describes the research investigations orientated to the starting and propelling of a solid fuel rocket engine which operates as combined cycle propulsion system using three thrust pulses. The vehicle has been designed to minimise the cost of launching small number of Nano/Cube satellites into low earth orbits (LEO). A technology described in this paper is a ground-based launch propulsion system which starts the rocket vertical motion immediately causing air flow to enter the ramjet’s intake. Current technology has a ramjet operation predicted to be able to start high subsonic speed of 280 m/s using a liquid fuel ramjet (LFRJ). The combined cycle engine configuration is in many ways fundamentally different from the LFRJ. A much lower subsonic start speed is highly desirable since the use of a mortar to obtain the latter speed for rocket means a shorter launcher length can be utilized. This paper examines the means and has some performance calculations, including Computational Fluid Dynamics analysis of air-intake at suitable operational conditions, 3-DOF point mass trajectory analysis of multi-pulse propulsion system (where pulse ignition time and thrust magnitude can be controlled), etc. of getting a combined cycle rocket engine use in a single stage vehicle.

Keywords: combine cycle propulsion system, low earth orbit launch vehicle, computational fluid dynamics analysis, 3dof trajectory analysis

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Authors: Hiroko Komatsu, Kaori Yagasaki

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Background: Cancer-related cognitive impairment is a common problem seen in cancer patients undergoing chemotherapy. Physical activity may show beneficial effects on the cognitive function in such patients. Therefore, we have developed a self-directed home yoga program for cancer patients with cognitive symptoms during chemotherapy. This program involves a DVD presenting a combination of yoga courses based on patient preferences to be practiced at home. This study was performed to examine the feasibility of this program. In addition, we also examined changes in cognitive function and quality of life (QOL) in these patients participating in the program. Methods: This prospective feasibility study was conducted in a 500-bed general hospital in Tokyo, Japan. The study population consisted of breast cancer patients undergoing chemotherapy as the initial therapy. This feasibility study used a convenience sample with estimation of recruitment rate in a single facility with the availability of trained nurses and physicians to ensure safe yoga intervention. The aim of the intervention program was to improve cognitive function by means of both physical and mental activation via yoga, consisting of physical practice, breathing exercises, and meditation. Information on the yoga program was provided as a booklet, with an instructor-guided group yoga class during the orientation, and a self-directed home yoga program on DVD with yoga logs. Results: The recruitment rate was 44.7%, and the study population consisted of 18 women with a mean age of 43.9 years. This study showed high rates of retention, adherence, and acceptability of the yoga program. Improvements were only observed in the cognitive aspects of fatigue, and there were serious adverse events during the program. Conclusion: The self-directed home yoga program discussed here was both feasible and safe for breast cancer patients showing cognitive symptoms during chemotherapy. The patients also rated the program as useful, interesting, and satisfactory. Participation in the program was associated with improvements in cognitive fatigue but not cognitive function.

Keywords: yoga, cognition, breast cancer, chemotherapy, quality of life

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Authors: Faisal Salah, Z. A. Aziz, K. K. Viswanathan

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In this article, the effects of g-jitter induced and combined with heat and mass transfer by mixed convection of MHD Maxwell fluid in microgravity situation is investigated for a simple system. This system consists of two heated vertical parallel infinite flat plates held at constant but different temperatures and concentrations. By using modified Darcy’s law, the equations governing the flow are modelled. These equations are solved analytically for the induced velocity, temperature and concentration distributions. Many interesting available results in the relevant literature (i.e. Newtonian fluid) is obtained as the special case of the present general analysis. Finally, the graphical results for the velocity profile of the oscillating flow in the channel are presented and discussed for different values of the material constants.

Keywords: g-jitter, heat and mass transfer, mixed convection, Maxwell fluid, porous medium

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Authors: Melissa Dorsey

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Moral distress and compassion fatigue plague nurses in the Cardiothoracic Intensive Care Unit (CTICU) and cause an unnecessary level of turnover. Dueling Burnout describes an initiative that was implemented in the CTICU to reduce the level of burnout the nurses endure by encouraging dual roles with collaborating departments. Purpose: Critical care nurses are plagued by burnout, moral distress, and compassion fatigue due to the intensity of care provided. The purpose of the dual role program was to decrease these issues by providing relief from the intensity of the critical care environment while maintaining full-time employment. Relevance/Significance: Burnout, moral distress, and compassion fatigue are leading causes of Cardiothoracic Critical Care (CTCU) turnover. A contributing factor to burnout is the workload related to serving as a preceptor for a constant influx of new nurses (RN). As a result of these factors, the CTICU averages 17% nursing turnover/year. The cost, unit disruption, and, most importantly, distress of the clinical nurses required an innovative approach to create an improved work environment and experience. Strategies/Implementation/Methods: In May 2018, a dual role pilot was initiated for nurses. The dual role constitutes .6 full-time equivalent hours (FTE) worked in CTICU in combination with .3 FTE worked in the Emergency Department (ED). ED nurses who expressed an interest in cross-training to CTICU were also offered the dual role opportunity. The initial hypothesis was that full-time employees would benefit from a change in clinical setting leading to increased engagement and job satisfaction. The dual role also presents an opportunity for professional development through the expansion of clinical skills in another specialty. Success of the pilot led to extending the dual role to areas beyond the ED. Evaluation/Outcomes/Results: The number of dual role clinical nurses has grown to 22. From the dual role cohort, only one has transferred out of CTICU. This is a 5% turnover rate for this group of nurses as compared to the average turnover rate of 17%. A role satisfaction survey conducted with the dual role cohort found that because of working in a dual role, 76.5% decreased their intent to leave, 100% decreased their level of burnout, and 100% reported an increase in overall job satisfaction. Nurses reported the ability to develop skills that are transferable between departments. Respondents emphasized the appreciation gained from working in multiple environments; the dual role served to transform their care. Conclusions/Implications: Dual role is an effective strategy to retain experienced nurses, decrease burnout and turnover, improve collaboration, and provide flexibility to meet staffing needs. The dual role offers RNs an expansion of skills, relief from high acuity and orientee demands, while improving job satisfaction.

Keywords: nursing retention, burnout, pandemic, strategic staffing, leadership

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Authors: Jingpeng Gao, Xinrui Mao, Zhibin Deng

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Aiming at the low recognition rate on the composite signal modulation in low signal to noise ratio (SNR), this paper proposes a modulation recognition algorithm based on ICanny-CNN. Firstly, the radar signal is transformed into the time-frequency image by Choi-Williams Distribution (CWD). Secondly, we propose an image processing algorithm using the Guided Filter and the threshold selection method, which is combined with the hole filling and the mask operation. Finally, the shallow convolutional neural network (CNN) is combined with the idea of the depth-wise convolution (Dw Conv) and the point-wise convolution (Pw Conv). The proposed CNN is designed to complete image classification and realize modulation recognition of radar signal. The simulation results show that the proposed algorithm can reach 90.83% at 0dB and 71.52% at -8dB. Therefore, the proposed algorithm has a good classification and anti-noise performance in radar signal modulation recognition and other fields.

Keywords: modulation recognition, image processing, composite signal, improved Canny algorithm

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Authors: Soheil Mohtaram, Wu Weidong, Yashar Aryanfar

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This research investigates the points with heat recovery potential in a triple-pressure cogeneration combined cycle power plant and determines the amount of waste heat that can be recovered. A modified cycle arrangement is then adopted for accessing thermal potentials. Modeling the energy system is followed by thermodynamic and energetic evaluation, and then the price of the manufactured products is also determined using the Total Revenue Requirement (TRR) method and term economic analysis. The results of optimization are then presented in a Pareto chart diagram by implementing a new model with dual objective functions, which include power cost and produce heat. This model can be utilized to identify the optimal operating point for such power plants based on electricity and heat prices in different regions.

Keywords: heat loss, recycling, unused energy, efficient production, optimization, triple-pressure cogeneration

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Authors: Sarah Elsayed Mohammed, Lamiaa Ahmed Ahmed, Mahmoud Mohammed Khattab

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Aim: The aim of the present study was to investigate whether combined nicorandil and bone marrow-derived mesenchymal stem cells (BMDMSC) treatment could offer an additional benefit in ameliorating isoproterenol (ISO)-induced heart failure in rats. Methods: ISO (85 and 170 mg/kg/day) was injected subcutaneously for 2 successive days, respectively. By day 3, electrocardiographic changes were recorded and serum was separated for determination of CK-MB level for confirmation of myocardial damage. Nicorandil (3 mg/kg/day) was then given orally with or without a single i.v. BMDMSC administration. Electrocardiography and echocardiography were recorded 2 weeks after beginning of treatment. Rats were then sacrificed and ventricles were isolated for estimation of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) contents, caspase-3 activity as well as inducible nitric oxide synthase (iNOS) and connexin-43 protein expressions. Moreover, histological analysis of myocardial fibrosis was performed and cryosections were done for estimation of homing of BMDMSC. Results: ISO induced a significant increase in ventricles/body weight ratio, left ventricular end diastolic (LVEDD) and systolic dimensions (LVESD), ST segment and QRS duration. Moreover, myocardial fibrosis as well as VEGF, TNF-α and TGF-β contents were significantly increased. On the other hand, connexin-43 protein expression was significantly decreased, while caspase-3 and iNOS protein expressions were significantly increased. Combined therapy provided additional improvement compared to cell treatment alone towards reducing cardiac hypertrophy, fibrosis and inflammation. Furthermore, combined therapy induced significant increase in angiogenesis and BMDMSC homing and prevented ISO induced changes in iNOS, connexin-43 and caspase-3 protein expressions. Conclusion: Combined nicorandil/BMDMSC treatment was superior to BMDMSC alone towards preventing ISO-induced heart failure in rats.

Keywords: fibrosis, isoproterenol, mesenchymal stem cells, nicorandil

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Authors: Samir Kumar Pal

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Background: Targeted rapid degradation of bilirubin has the potential to thwart incipient bilirubin encephalopathy. Uncontrolled hyperbilirubinemia is a potential problem in developing countries, including India, because of the lack of reliable healthcare institutes for conventional phototherapy. In India, most of the rural subjects duel in the exchange limit during transport, leading to a risk of kernicterus when they arrive at the treatment centre. Thus, an alternative pharmaceutical agent is needed for the hours. Objective: Exploration of a distinct therapeutic strategy for the control of neonatal hyperbilirubinemia compared to conventional phototherapy in a clinical setting. Method: We synthesized, characterized and investigated a spinel-structured Manganese citrate nanocomplex (C-Mn₃O₄ NC, the nanodrug) along with conventional phototherapy in neonatal subjects. We have also observed BIND scores in order to assess neurological dysfunctions. Results: Our observational study clearly reveals that the rate of declination of bilirubin in neonatal subjects with nanodrug oral administration and phototherapy is faster compared to that in the case of phototherapy only. The associated neural dysfunctions were also found to be significantly lower in the case of combined therapy. Conclusion: This study demonstrates that combined therapy works better than conventional phototherapy only for the control of hyperbilirubinemia. We have observed that a significant portion of neonatal subjects requiring blood exchange has been prevented with the combined therapeutic strategy. Further compilation of a drug-safety-dossier is warranted to translate this novel therapeutic chemo preventive approach to clinical settings.

Keywords: nanodrug, nanoparticle, Neonatal hyperbilirubinemia, alternative to phototherapy, redox modulation, redox medicine

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Authors: Yaya Gao, Bing Zhong, Yafeng Liu, Fei Chen

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Aim: The purpose of this study was to explore the difference between acellular dermal matrix (ADM) combined with anterolateral thigh (ALT) flap and ALT flap alone. Methods: HSCC patients were treated and divided into group A (ALT) and group B (ALT+ADM) between January 2014 and December 2018. We compared and analyzed the intraoperative information and postoperative outcomes of the patients. Results: There were 21 and 17 patients in group A and group B, respectively. The operation time, blood loss, defect size and anastomotic vessel selection showed no significant difference between two groups. The postoperative complications, including wound bleeding (n=0 vs. 1, p=0.459), wound dehiscence (n=0 vs. 1, p=0.459), wound infection (n=5vs.3, p=0.709), pharyngeal fistula (n=5vs.4, p=1.000) and hypoproteinemia (n=11 vs. 12, p=0.326) were comparable between the groups. Dysphagia at 6 months (number of liquid diets=0vs. 0; number of partial tube feedings=1vs. 1; number of total tube feedings=1vs. 0, p=0.655) also showed no significant differences. However, significant differences was observed in dysphagia at 12 months (number of liquid diets=0vs. 0; number of partial tube feedings=3 vs. 1; number of total tube feedings=10vs. 1, p=0.006). Conclusion: For HSCC patients, the use of the ALT flap combined ADM, compared to ALT treatment, showed better swallowing function at 12 months. The ALT flap combined ADM may serve as a safe and feasible alternative for selected HSCC patients.

Keywords: hypopharyngeal squamous cell carcinoma, anterolateral thigh free flap, acellular dermal matrix, reconstruction, dysphagia

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Authors: Alessandra Turini Bolsoni-Silva, Sonia Regina Loureiro

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It is important to evaluate such variables simultaneously and differentiating types of behavior problems: internalizing, externalizing and with comorbidity of internalizing and externalizing. The objective was to compare, correlate and predict teacher educational practices (educational social skills and negative practices) and children's behaviors (social skills and behavior problems) of children with internalizing, externalizing and combined internalizing and externalizing problems, controlling variables of child (gender and education). A total of 262 children were eligible to compose the participants, considering preschool age from 3 to 5 years old (n = 109) and school age from 6 to 11 (n = 153) years old, and their teachers who were distributed, in designs case-control, non-clinical, with internalizing, externalizing problems and internalizing and externalizing comorbidity, using the Teacher's Report Form (TRF) as a criterion. The instruments were applied with the teachers, after consent from the parents/guardians: a) Teacher’s Report Form (TRF); b) Educational Social Skills Interview Guide for Teachers (RE-HSE-Pr); (c) Socially Skilled Response Questionnaire – Teachers (QRSH-Pr). The data were treated by univariate and multivariate analyses, proceeding with comparisons, correlations and predictions regarding the outcomes of children with and without behavioral problems, considering the types of problems. As main results stand out: (a) group comparison studies: in the Inter group there is emphasis on behavior problems in affection interactions, which does not happen in the other groups; as for positive practices, they discriminate against groups with externalizing and combined problems and not in internalizing ones, positive educational practices – hse are more frequent in the G-Exter and G-Inter+Exter groups; negative practices differed only in the G-Exter and G-Inter+Exter groups; b) correlation studies: it can be seen that the Inter+Exter group presents a greater number of correlations in the relationship between behavioral problems/complaints and negative practices and between children's social skills and positive practices/contexts; c) prediction studies: children's social skills predict internalizing, externalizing and combined problems; it is also verified that the negative practices are in the multivariate model for the externalizing and combined ones. This investigation collaborates in the identification of risk and protective factors for specific problems, helping in interventions for different problems.

Keywords: development, educational practices, social skills, behavior problems, teacher

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Authors: A. Falsafi, M. Dadkhah, S. Shahidi

Abstract:

The destruction and defeat of drill pipes and drill rigs in oil wells often combined with a combination of shear modulus II and III. In such a situation, the strength and load bearing capacity of the drill are evaluated based on the principles of fracture mechanics and crack growth criteria. In this paper, using the three-dimensional stress equations around the Turkish frontier, the relations of the tense-tense criterion (MTS) are extracted for the loading of the combined II and III modulus. It is shown that in crisp deflection under loading of combination II and III, the level of fracture is characterized by two different angles: the longitudinal angle of deflection θ and the angle of the deflection of the alpha. Based on the relationships obtained from the MTS criterion, the failure criteria, the longitudinal angle of the theta failure and the lateral angle of the failure of the alpha are presented. Also, the role of Poisson's coefficient on these parameters is investigated in these graphs.

Keywords: most tangential tension criterion, longitudinal angle of failure, side angle of fracture, drills crack

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Authors: Nathen A. Spitz, Dennis Martin Kivlighan III, Arwa Aburizik

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Background and Purpose: Presently, there is a paucity of naturalistic studies that directly compare the effectiveness of psychotherapy versus concurrent psychotherapy and psychiatric care for the treatment of depression and anxiety in cancer patients. Informed by previous clinical trials examining the efficacy of concurrent approaches, this study sought to test the hypothesis that a combined approach would result in the greatest reduction of depression and anxiety symptoms. Methods: Data for this study consisted of 433 adult cancer patients, with 252 receiving only psychotherapy and 181 receiving concurrent psychotherapy and psychiatric care at the University of Iowa Hospitals and Clinics. Longitudinal PHQ9 and GAD7 data were analyzed between both groups using latent growth curve analyses. Results: After controlling for treatment length and provider effects, results indicated that concurrent care was more effective than psychotherapy alone for depressive symptoms (γ₁₂ = -0.12, p = .037). Specifically, the simple slope for concurrent care was -0.25 (p = .022), and the simple slope for psychotherapy alone was -0.13 (p = .006), suggesting that patients receiving concurrent care experienced a greater reduction in depressive symptoms compared to patients receiving psychotherapy alone. In contrast, there were no significant differences between psychotherapy alone and concurrent psychotherapy and psychiatric care in the reduction of anxious symptoms. Conclusions: Overall, as both psychotherapy and psychiatric care may address unique aspects of mental health conditions, in addition to potentially providing synergetic support to each other, a combinatorial approach to mental healthcare for cancer patients may improve outcomes.

Keywords: psychiatry, psychology, psycho-oncology, combined care, psychotherapy, behavioral psychology

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Authors: A. Rong, P. B. Luh, R. Lahdelma

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High penetration of intermittent renewable energy sources (RES) such as solar power and wind power into the energy system has caused temporal and spatial imbalance between electric power supply and demand for some countries and regions. This brings about the critical need for coordinating power production and power exchange for different regions. As compared with the power-only systems, the combined heat and power (CHP) systems can provide additional flexibility of utilizing RES by exploiting the interdependence of power and heat production in the CHP plant. In the CHP system, power production can be influenced by adjusting heat production level and electric power can be used to satisfy heat demand by electric boiler or heat pump in conjunction with heat storage, which is much cheaper than electric storage. This paper addresses multi-site CHP systems without considering RES, which lay foundation for handling penetration of RES. The problem under study is the unit commitment (UC) of the transmission-constrained multi-site CHP systems. We solve the problem by combining linear relaxation of ON/OFF states and sequential dynamic programming (DP) techniques, where relaxed states are used to reduce the dimension of the UC problem and DP for improving the solution quality. Numerical results for daily scheduling with realistic models and data show that DP-based algorithm is from a few to a few hundred times faster than CPLEX (standard commercial optimization software) with good solution accuracy (less than 1% relative gap from the optimal solution on the average).

Keywords: dynamic programming, multi-site combined heat and power system, relaxed states, transmission-constrained generation unit commitment

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Authors: M. Varmaziar

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Magnesium (Mg) is an essential mineral that plays a crucial role in the human body. Certain types of foods, including nuts, grains, fruits, vegetables, and whole grains, are rich sources of magnesium. Mg serves as an essential cofactor for numerous enzymatic reactions, including energy metabolism, cellular growth, glycolysis, and protein synthesis. The Mg-ATP complex serves as an energy source and is vital for many physiological functions, including nerve conduction, muscle contraction, and blood pressure regulation. Despite the vital role of magnesium in energy metabolism, maintaining adequate magnesium intake is often overlooked among the general population and athletes. The aim of this study was to investigate the effect of magnesium supplementation on the physical activities of field athletes. Field athletes were divided into two groups: those who consumed magnesium supplements and those who received a placebo. These two groups received either 500 mg of magnesium oxide or a placebo daily for 8 weeks. At the beginning and end of the study, athletes completed ISI questionnaires and physical activity assessments. Nutritional analyses were performed using N4 software, and statistical analyses were conducted using SPSS19 software. The results of this study revealed a significant difference between the two study groups. Athletes who received magnesium supplements experienced less fatigue related to field athletic activities and muscle soreness. In contrast, athletes who received the placebo reported more significant fatigue and muscle soreness. A concerning finding in these results is that the performance of athletic activities may be at risk with low magnesium levels. Therefore, magnesium is essential for maintaining health and plays a crucial role in athletic performance. Consuming a variety of magnesium-rich foods ensures that individuals receive an adequate amount of this essential nutrient in their diet. The consumption of these foods improves performance parameters in athletic exercises.

Keywords: athletic performance, effect, field athletes, magnesium supplement

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Authors: C. Trapp, A. Vijay, M. Khorasani

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Decentralised micro-grids with sector coupling can combat the spatial and temporal intermittence of renewable energy by combining power, transportation and infrastructure sectors. Intelligent energy conversion concepts such as electrolysers, hydrogen engines and fuel cells combined with energy storage using intelligent batteries and hydrogen storage form the back-bone of such a system. This paper describes a micro-grid based on Photo-Voltaic cells, battery storage, innovative modular and scalable Anion Exchange Membrane (AEM) electrolyzer with an efficiency of up to 73%, high-pressure hydrogen storage as well as cutting-edge combustion-engine based Combined Heat and Power (CHP) plant with more than 85% efficiency at the university campus to address the challenges of decarbonization whilst eliminating the necessity for expensive high-voltage infrastructure.

Keywords: sector coupling, micro-grids, energy self-sufficiency, decarbonization, AEM electrolysis, hydrogen CHP

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Authors: Lalit Tejwani, Reetika Sharma, Arun Singhvi, Himanshu Shekhar

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Purpose: To assess the efficacy of collagen matrix implant (Ologen) in phacotrabeculectomy augmented with mitomycin C (MMC). Methods: A biodegradable collagen matrix (Ologen) was placed in the subconjunctival and subscleral space in twenty-two eyes of 22 patients with glaucoma and cataract who underwent combined phacoemulsification and trabeculectomy augmented with MMC. All of them were examined preoperatively and on the first postoperative day. They were followed for twelve months after surgery. Any intervention needed in follow-up period was noted. Any complication was recorded. The primary outcome measure was postoperative intraocular pressure at one year follow-up. Any additional postoperative treatments needed and adverse events were noted. Results: The mean age of patients included in the study was 57.77 ± 9.68 years (range=36 to 70 years). All the patients were followed for at least one year. Three patients had history of failed trabeculectomy. Fifteen patients had chronic angle closure glaucoma with cataract, five had primary open angle glaucoma with cataract, one had uveitic glaucoma with cataract, and one had juvenile open angle glaucoma with cataract. Mean preoperative IOP was 32.63 ± 8.29 mm Hg, eighteen patients were on oral antiglaucoma medicines. The mean postoperative IOP was 10.09 ± 2.65 mm Hg at three months, 10.36 ± 2.19 mm Hg at six months and 11.36 ± 2.72 mm Hg at one year follow up. No adverse effect related to Ologen was seen. Anterior chamber reformation was done in five patients, and three needed needling of bleb. Four patients needed additional antiglaucoma medications in the follow-up period. Conclusions: Combined phacotrabeculectomy with MMC with Ologen implantation appears to be a safe and effective option in glaucoma patients needing trabeculectomy with significant cataract. Comparative studies with longer duration of follow-up in larger number of patients are needed.

Keywords: combined surgery, ologen, phacotrabeculectomy, success

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Authors: Ting-Ting Wen, H. C. Lin

Abstract:

This paper reports a study for the light outcoupling efficiency of the PLED device. In use of a designed substrate combined with nano-line patterns in PLED device, the light outcoupling efficiency can be significantly enhanced. The designed substrate was made by UV imprinting technology, such as triangular microlens arrays on the front and periodic corrugated patterns on the back surface. The nano-line patterns in PLED device was fabricated by advanced microstamping and ink-jet printing techniques. For high angles of observation with respect to the substrate surface normal, the light out intensity of the developed PLED device is increased from 0.05 (a.u.) up to 0.69 (a.u.) at the view angle 85 degree. The designed integration leads to 64% increase of the light out intensity compared with the conventional PLED device.

Keywords: triangular microlens, corrugation patterns, nano-line patterns, PLED device, UV imprinting technology, microstamping

Procedia PDF Downloads 459