Search results for: enrichment factor

Authors: Emmanuel Okine Neokye Serge Dossou Martin Iniga Bortey Nketia Alabi-Doku

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Fish stock distribution is greatly influenced by oceanographic environmental conditions. Temporal variations of temperature and other oceanic properties, resulting from climate change have been documented to have a strong impact on fisheries and aquaculture. In Ghana, Sardinella species are one of the most important fisheries resources; they constitute about 60% of the total catch of coastal fisheries and are more predominant during the upwelling season. The present study investigated the role of physical oceanographic environmental conditions in the catches of Sardinella species: S. aurita and S. maderensis, which were landed in Ghana. Furthermore, we examined the relationship between environmental conditions and catches of Sardinella species for seasonal and interannual variations between 2005 and 2015. For oceanographic environmental factors, we used comprehensive datasets, which consist of :(1) daily in situ SST data obtained at two coastal stations in Ghana; (i) Cape 3 Points (4.7° N, -2.09° W) and (ii) Tema (5° N, 0° E), for the period 2005–2015, (2) Monthly SST data (MOAA GPV) from JAMSTEC, and (3) gridded 10 metre wind data from CCMP reanalysis. The analysis of the data collected showed that higher (lower) wind velocity forms stronger (weaker) coastal upwelling that is detected by lower (higher) SST, resulting in a higher (lower) catch of Sardinella spp., in both seasonal and interannual variations. It was also observed that the capture ability of small pelagic fish species such as Sardinella spp. is depend on the intensity of the coastal upwelling. Moreso, the Atlantic Meridional Mode index (climatic index) is now known to be a possible factor to the interannual variation in catch of small pelagic fish species.

Keywords: Sardinella spp., fish, climate change, Ghana

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Authors: Mamidi Ramakrishna Rao

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Doubly-fed induction generator (DFIG) is currently the choice for many wind turbines. These generators, when connected to the grid through a converter, is subjected to varied power system conditions like voltage variation, frequency variation, short circuit fault conditions, etc. Further, many countries like Canada, Germany, UK, Scotland, etc. have distinct grid codes relating to wind turbines. Accordingly, following the network faults, wind turbines have to supply a definite reactive current. To satisfy the requirements including reactive current capability, an optimum electrical design becomes a mandate for DFIG to function. This paper intends to optimize the equivalent circuit parameters of an electrical design for satisfactory DFIG performance. Direct search method has been used for optimization of the parameters. The variables selected include electromagnetic core dimensions (diameters and stack length), slot dimensions, radial air gap between stator and rotor and winding copper cross section area. Optimization for 2 MW DFIG has been executed separately for three objective functions - maximum reactive power capability (Case I), maximum efficiency (Case II) and minimum weight (Case III). In the optimization analysis program, voltage variations (10%), power factor- leading and lagging (0.95), speeds for corresponding to slips (-0.3 to +0.3) have been considered. The optimum designs obtained for objective functions were compared. It can be concluded that direct search method of optimization helps in determining an optimum electrical design for each objective function like efficiency or reactive power capability or weight minimization.

Keywords: direct search, DFIG, equivalent circuit parameters, optimization

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Authors: Daryl Clement Knutt, Neela Badrie, Marsha Singh

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Quality assurance and product labelling are vital in the food and drink industry, as a tactical tool in a competitive environment. The food label is a principal marketing tool which also serves as a regulatory mechanism in the safeguarding of consumer well –being. The objective of this study was to evaluate the level of consumers’ use and understanding of food labeling information and knowledge pertaining to food quality assurance systems. The study population consisted of Trinidadian adults, who were over the age of 18 (n=384). Data collection was conducted via a self-administered questionnaire, which contained 31 questions, comprising of four sections: I. socio demographic information; II. food quality and quality assurance; III. use of Labeling information; and IV. laws and regulations. Sampling was conducted at six supermarkets, in five major regions of the country over a period of three weeks in 2014. The demographic profile of the shoppers revealed that majority was female (63.6%). The gender factor and those who were concerned about the nutrient content of their food, were predictive indicators of those who read food labels. Most (93.1%) read food labels before purchase, 15.4% ‘always’; 32.5% ‘most times’ and 45.2% ‘sometimes’. Some (42%) were often satisfied with the information presented on food labels, whilst 35.7% of consumers were unsatisfied. When the respondents were questioned on their familiarity with terms ‘food quality’ and ‘food quality assurance’, 21.3% of consumers replied positively - ‘I have heard the terms and know a lot’ whilst 37% were only ‘somewhat familiar’. Consumers were mainly knowledgeable of the International Standard of Organization (ISO) (51.5%) and Good Agricultural Practices GAP (38%) as quality tools. Participants ranked ‘nutritional information’ as the number one labeling element that should be better presented, followed by ‘allergy notes’ and ‘best before date’. Females were more inclined to read labels being the household shoppers. The shoppers would like better presentation of the food labelling information so as to guide their decision to purchase a product.

Keywords: food labels, food quality, nutrition, marketing, Trinidad, Tobago

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Authors: Ahmed M. Khedr, Saad M. Abdelrahman, Kareem M. Tonbol

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Two geo-referenced sea level datasets (September 2008 – November 2010) and (April 2012 – January 2014) were recorded at Alexandria Western Harbour (AWH). Accurate re-definition of tidal datum, referred to the latest International Terrestrial Reference Frame (ITRF-2014), was discussed and updated to improve our understanding of the old predefined tidal datum at Alexandria. Tidal and non-tidal components of sea level were separated with the use of Delft-3D hydrodynamic model-tide suit (Delft-3D, 2015). Tidal characteristics at AWH were investigated and harmonic analysis showed the most significant 34 constituents with their amplitudes and phases. Tide was identified as semi-diurnal pattern as indicated by a “Form Factor” of 0.24 and 0.25, respectively. Principle tidal datums related to major tidal phenomena were recalculated referred to a meaningful geodetic height datum. The portion of residual energy (surge) out of the total sea level energy was computed for each dataset and found 77% and 72%, respectively. Power spectral density (PSD) showed accurate resolvability in high band (1–6) cycle/days for the nominated independent constituents, except some neighbouring constituents, which are too close in frequency. Wind and atmospheric pressure data, during the recorded sea level time, were analysed and cross-correlated with the surge signals. Moderate association between surge and wind and atmospheric pressure data were obtained. In addition, long-term sea level rise trend at AWH was computed and showed good agreement with earlier estimated rates.

Keywords: Alexandria, Delft-3D, Egypt, geodetic reference, harmonic analysis, sea level

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Authors: Usama Mohamed, Sam Booth, Aliysn J. Nedoma

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As part of the transition to electric vehicles, there has been a recent increase in demand for battery manufacturing. Cathodes typically account for approximately 50% of the total lithium-ion battery cell cost and are a pivotal factor in determining the viability of new industrial infrastructure. Cathodes which offer lower costs whilst maintaining or increasing performance, such as nickel-rich layered cathodes, have a significant competitive advantage when scaling up the manufacturing process. This project evaluates the techno-economic value proposition of an integrated industrial scale cathode active material (CAM) production process, closing the mass and energy balances, and optimizing the operation conditions using a sensitivity analysis. This is done by developing a process model of a co-precipitation synthesis route using Aspen Plus software and validated based on experimental data. The mechanism chemistry and equilibrium conditions were established based on previous literature and HSC-Chemistry software. This is then followed by integrating the energy streams, adding waste recovery and treatment processes, as well as testing the effect of key parameters (temperature, pH, reaction time, etc.) on CAM production yield and emissions. Finally, an economic analysis estimating the fixed and variable costs (including capital expenditure, labor costs, raw materials, etc.) to calculate the cost of CAM ($/kg and $/kWh), total plant cost ($) and net present value (NPV). This work sets the foundational blueprint for future research into sustainable industrial scale processes for CAM manufacturing.

Keywords: cathodes, industrial production, nickel-rich layered cathodes, process modelling, techno-economic analysis

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Authors: Habtamu Fufa, Yemane Berhane

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Child under nutrition has long-term consequences for intellectual ability, economic productivity, reproductive performance and susceptibility to metabolic and cardiovascular disease. The unacceptably high prevalence of malnutrition in young children of the region has not changed much over the last decades, which could make the achievement of the corresponding Millennium Development Goals very unlikely. Despite the well-documented problems of child malnutrition in Sub-Saharan Africa, there is few systematic review of evidences on determinants of child malnutrition in the region. The current available evidence on determinants of child under nutrition in Sub-Saharan Africa is systematically reviewed. The method used in searching relevant literature was using bio medical databases PUBMED, Google scholar and the website of the World Health Organization on nutrition using the following key words: "Determinants “, "Child Malnutrition", and "Sub- Saharan Africa". The search was limited to articles published in and after 1995 up to date. In all the reviewed articles, the data were analyzed using multivariate regression analysis and or odds ratios for significance of determinants in child malnutrition. Synthesis of 40 published articles from various countries of the region is done and noted that household economic status, maternal education, disease, breastfeeding practices, age and sex of a child, birth interval and residential areas were found to be determinants of child under nutrition. Poverty remains the main factor of malnutrition in Sub-Saharan Africa and poor education of parents aggravates the malnutrition through perpetuation of poor nutrition practices. Male children under five years are the most affected ones. Understanding of these determinants of poor nutritional attainment would provide insights in designing interventions for reducing the high levels of child malnutrition in this region. Large-scale multi-sectoral community-based interventions are urgently needed for a sustainable improvement of child nutritional & health status in Sub-Saharan Africa.

Keywords: child malnutrition, determinants, Sub-Saharan Africa, health status

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Authors: Benedictus Asriparusa

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In the area of the oil industry, there is accompanied by associated natural gas. The thing shows that a large amount of energy is being wasted mostly in the developing countries by contributing to the global warming process. This research represents an overview of methods in Minas area employed by these researchers in PT. Chevron Pacific Indonesia to determine ways of measuring and reducing gas flaring and its emission drastically. It provides an approximation includes analytical studies, numerical studies, modeling, computer simulations, etc. Flaring system is the controlled burning of natural gas in the course of routine oil and gas production operations. This burning occurs at the end of a flare stack or boom. The combustion process will release emissions of greenhouse gases such as NO2, CO2, SO2, etc. This condition will affect the air and environment around the industrial area. Therefore, we need a simulation to create the pattern of the dissemination of pollutant. This research paper has being made to see trends in gas flaring model and current developments to predict dominant variable which gives impact to dissemination of pollutant. Fluent models used to simulate the distribution of pollutant gas coming out of the stack. While WRF model output is used to overcome the limitations of the analysis of meteorological data and atmospheric conditions in the study area. This study condition focused on transition season in 2012 at Minas area. The goal of the simulation is looking for the exact time which is most influence towards dissemination of pollutants. The most influence factor divided into two main subjects. It is the quickest wind and the slowest wind. According to the simulation results, it can be seen that quickest wind moves to horizontal way and slowest wind moves to vertical way.

Keywords: flaring system, fluent model, dissemination of pollutant, transition season

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Authors: Mohammad Rahim Rahnama, Lia Shaddel

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Today, along with the development of urbanism, its negative consequences on the health of citizens are emerging. Mental disorders are common in the big cities, while mental health enables individuals to become active citizens. Meanwhile, women have a larger share of mental problems. Depression and anxiety disorders have a higher prevalence rate among women and these disorders affect the health of future generations, too. Therefore, improving women’s mental health through the potentials offered by urban spaces are of paramount importance. The present study aims to first, evaluate the spatial autocorrelation of women’s mental health and walkable spaces and then present solutions, based on the findings, to improve the walkability index. To determine the spatial distribution of women’s mental health in Mashhad, Moran's I was used and 1000 questionnaire were handed out in various sub-districts of Mashhad. Moran's I was calculated to be 0.18 which indicates a cluster distribution pattern. The walkability index was calculated using the four variables pertaining to the length of walkable routes, mixed land use, retail floor area ratio, and household density. To determine spatial autocorrelation of mental health and the walkability index, bivariate Moran’s I was calculated. Moran's I was determined to be 0.37 which shows a direct spatial relationship between variables; 4 clusters in 9 sub-districts of Mashhad were created. In High-Low cluster, there was a negative spatial relationship and hence, to identify factors affecting walkability in urban spaces semi-structures interviews were conducted with 21 women in this cluster. The findings revealed that security is the major factor influencing women’s walking behavior in this cluster. In accordance with the findings, some suggestions are offered to improve the presence of women in this sub-district.

Keywords: Mashhad, spatial autocorrelation, women’s mental health, walkability index

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Authors: Yousef M. Al-Roomi, Kaneez Fatema Hussain

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This work evaluates the thermal degradation kinetic parameters of CaSO₄-complex isolated after the inhibition effect of maleic-anhydride based polymer (YMR-polymers). Pyrolysis experiments were carried out at four heating rates (5, 10, 15 and 20°C/min). Several analytical model-free methods were used to determine the kinetic parameters, including Friedman, Coats and Redfern, Kissinger, Flynn-Wall-Ozawa and Kissinger-Akahira–Sunose methods. The Criado model fitting method based on real mechanism followed in thermal degradation of the complex has been applied to explain the degradation mechanism of CaSO₄-complex. In addition, a simple dynamic model was proposed over two temperature ranges for successive decomposition of CaSO₄-complex which has a combination of organic and inorganic part (adsorbed polymer + CaSO₄.2H₂O scale). The model developed enabled the assessment of pre-exponential factor (A) and apparent activation-energy (Eₐ) for both stages independently using a mathematical developed expression based on an integral solution. The unique reaction mechanism approach applied in this study showed that (Eₐ₁-160.5 kJ/mole) for organic decomposition (adsorbed polymer stage-I) has been lower than Eₐ₂-388 kJ/mole for the CaSO₄ decomposition (inorganic stage-II). Further adsorbed YMR-antiscalant not only reduced the decomposition temperature of CaSO₄-complex compared to CaSO₄-blank (CaSO₄.2H₂O scales in the absence of YMR-polymer) but also distorted the crystal lattice of the organic complex of CaSO₄ precipitates, destroying their compact and regular crystal structures observed from XRD and SEM studies.

Keywords: CaSO₄-complex, maleic-anhydride polymers, thermal degradation kinetics and mechanism, XRD and SEM studies

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Authors: Lucy Adesomon Okukpon, Margaret Omolara Akerele

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Higher Education in Nigeria is sought after by women, they believe that the economic power and growth lies in the attainment and pursuit of higher Education. No nation in the world can boast of developmental growth when the women are not fully empowered educationally. The attainment of higher education spurs women to contribute meaningfully towards the growth and development of the Nigerian workforce. Recent innovations and trends reveal that over fifty per cent of Nigerian women have attained higher education within and outside the country. Women in Nigeria have expressed their growing concern of what becomes of the remaining 50 per cent who are unable to attain basic education. This concern has brought about the issue of funding which is a practical challenge towards the attainment of education for these vulnerable women. Another challenging factor is that most women often seek the permission of their husbands, brothers, fathers and uncles to enable them attain educational pursuit, especially when the institution is miles away from their place of abode. The solution to this problems from research findings reveal that the umbrella body which co-ordinates education for women in Nigeria (The National Council of Women Societies, NCWS) have taken it upon itself to provide educational learning centres in all the states of the Federation including Abuja the Nations capital city. This is to stem the ugly trend and enable women gain access to educational facilities provided for their growth and development. This positive stride has brought succour to women who hitherto have no hope of attaining any form of education. Moreover, awareness creation concerning higher education is translated into different Nigerian languages so that the women at the grassroots can benefit immensely and contribute towards the growth and development of the Nation. Their educational progress attest to the fact that Nigerian Women are happy for the educational opportunities provided and have vowed to attain greater heights particularly where higher education is concerned.

Keywords: developmental growth, educational attainment, higher education, women in higher education, Nigeria

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Authors: Hyeon-Kyo Lim, Hyunjung Kim, Kune-Woo Lee

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Decommissioning process of nuclear facilities can be said to consist of a sequence of problem solving activities, partly because there may exist working environments contaminated by radiological exposure, and partly because there may also exist industrial hazards such as fire, explosions, toxic materials, and electrical and physical hazards. As for an individual hazard factor, risk assessment techniques are getting known to industrial workers with advance of safety technology, but the way how to integrate those results is not. Furthermore, there are few workers who experienced decommissioning operations a lot in the past. Therefore, not a few countries in the world have been trying to develop appropriate counter techniques in order to guarantee safety and efficiency of the process. In spite of that, there still exists neither domestic nor international standard since nuclear facilities are too diverse and unique. In the consequence, it is quite inevitable to imagine and assess the whole risk in the situation anticipated one by one. This paper aimed to find out an appropriate technique to integrate individual risk assessment results from the viewpoint of experts. Thus, on one hand the whole risk assessment activity for decommissioning operations was modeled as a sequence of individual risk assessment steps, and on the other, a hierarchical risk structure was developed. Then, risk assessment procedure that can elicit individual hazard factors one by one were introduced with reference to the standard operation procedure (SOP) and hierarchical task analysis (HTA). With an assumption of quantification and normalization of individual risks, a technique to estimate relative weight factors was tried by using the conventional Analytic Hierarchical Process (AHP) and its result was reviewed with reference to judgment of experts. Besides, taking the ambiguity of human judgment into consideration, debates based upon fuzzy inference was added with a mathematical case study.

Keywords: decommissioning, risk assessment, analytic hierarchical process (AHP), fuzzy inference

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Authors: Luan Vardari, Dena Arapi-Vardari

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Financial stability is a critical component of economic growth and development, and it has been recognized as a key policy objective in many countries around the world. In the Western Balkans, financial stability has been a key issue in recent years, with a number of challenges facing the region, including high levels of public debt, weak banking systems, and economic volatility. Corporate finance, which refers to the financial management practices of firms, is an important factor that can impact financial stability. This paper aims to investigate corporate finance's impact on financial stability in Western Balkan countries. This study will use a mixed-methods approach to investigate the impact of corporate finance on financial stability in the Western Balkans. The study will begin with a comprehensive review of the existing literature on corporate finance and financial stability, focusing on the Western Balkan region. This will be followed by an empirical analysis of regional corporate finance practices using data from various industries and firms. The analysis will explore the relationship between corporate finance practices and financial stability, taking into account factors such as regulatory frameworks, economic conditions, and firm size. The results of the study are expected to provide insights into the impact of corporate finance on financial stability in the Western Balkans. Specifically, the study will identify the key corporate finance practices that contribute to financial stability in the region, as well as the challenges and obstacles that firms face in implementing effective corporate finance strategies. The study will also provide recommendations for policymakers and firms looking to enhance financial stability and resilience in the region.

Keywords: financial regulation, debt management, investment decisions, dividend policies, economic volatility, banking systems, public debt, prudent financial management, firm size, policy recommendations

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Authors: Kelechi E. Ezeji

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The inclusion of relevant content in curricula of architecture schools is vital for attainment of Computer Aided Design (CAD) proficiency by graduates. Implementing this content involves, among other variables, the presence of competent tutors. Consequently, this study sought to investigate the importance of personnel recruitment for inclusion of content vital to the implementation of CAD in the curriculum for architecture education. This was with a view to developing a framework for appropriate implementation of CAD curriculum. It was focused on departments of architecture in universities in south-east Nigeria which have been accredited by National Universities Commission. Survey research design was employed. Data were obtained from sources within the study area using questionnaires, personal interviews, physical observation/enumeration and examination of institutional documents. A multi-stage stratified random sampling method was adopted. The first stage of stratification involved random sampling by balloting of the departments. The second stage involved obtaining respondents’ population from the number of staff and students of sample population. Chi Square analysis tool for nominal variables and Pearson’s product moment correlation test for interval variables were used for data analysis. With ρ < 0.5, the study found significant correlation between the number of CAD literate academic staff and use of CAD in design studio/assignments; that increase in the overall number of teaching staff significantly affected total CAD credit units in the curriculum of the department. The implications of these findings were that for successful implementation leading to attainment of CAD proficiency to occur, CAD-literacy should be a factor in the recruitment of staff and a policy of in-house training should be pursued.

Keywords: computer-aided design, education, personnel recruitment, curriculum

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Authors: Sitarrine Thongpussawal, Hui Shao, Clark Gantzer

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Terracing is a conservation practice to reduce erosion and widely used for soil and water conservation throughout the world but is relatively expensive. A modification of the Soil and Water Assessment Tool (called SWAT-Terrace or SWAT-T) explicitly aims to improve the simulation of the hydrological process of erosion from the terraces. SWAT-T simulates erosion from the terraces by separating terraces into three segments instead of evaluating the entire terrace. The objective of this work is to evaluate the terrace benefits on erosion from the Goodwater Creek Experimental Watershed (GCEW) at watershed and Hydrologic Response Unit (HRU) scales using SWAT-T. The HRU is the smallest spatial unit of the model, which lumps all similar land uses, soils, and slopes within a sub-basin. The SWAT-T model was parameterized for slope length, steepness and the empirical Universal Soil Erosion Equation support practice factor for three terrace segments. Data from 1993-2010 measured at the watershed outlet were used to evaluate the models for calibration and validation. Results of SWAT-T calibration showed good performance between measured and simulated erosion for the monthly time step, but poor performance for SWAT-T validation. This is probably because of large storms in spring 2002 that prevented planting, causing poorly simulated scheduling of actual field operations. To estimate terrace benefits on erosion, models were compared with and without terraces. Results showed that SWAT-T showed significant ~3% reduction in erosion (Pr <0.01) at the watershed scale and ~12% reduction in erosion at the HRU scale. Studies using the SWAT-T model indicated that the terraces have advantages to reduce erosion from terraced-agricultural watersheds. SWAT-T can be used in the evaluation of erosion to sustainably conserve the soil and water.

Keywords: Erosion, Modeling, Terraces, SWAT

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Authors: Amir Zeb, Shailima Rampogu, Minky Son, Ayoung Baek, Sang H. Yoon, Keun W. Lee

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Neurotoxic insults activate calpain, which in turn produces truncated p25 from p35. p25 forms hyperactivated Cdk5/p25 complex, and thereby induces severe neuropathological aberrations including hyperphosphorylated tau, neuroinflammation, apoptosis, and neuronal death. Inhibition of Cdk5/p25 complex alleviates aberrant phosphorylation of tau to mitigate AD pathology. PHA-793887 and Roscovitine have been investigated as selective inhibitors of Cdk5/p25 with IC50 values 5nM and 160nM, respectively, but their mechanistic studies remain unknown. Herein, computational simulations have explored the binding mode and interaction mechanism of PHA-793887 and Roscovitine with Cdk5/p25. Docking results suggested that PHA-793887 and Rsocovitine have occupied the ATP-binding site of Cdk5 and obtained highest docking (GOLD) score of 66.54 and 84.03, respectively. Furthermore, molecular dynamics (MD) simulation demonstrated that PHA-793887 and Roscovitine established stable RMSD of 1.09 Å and 1.48 Å with Cdk5/p25, respectively. Profiling of polar interactions suggested that each inhibitor formed hydrogen bonds (H-bond) with catalytic residues of Cdk5 and could remain stable throughout the molecular dynamics simulation. Additionally, binding free energy calculation by molecular mechanics/Poisson–Boltzmann surface area (MM/PBSA) suggested that PHA-793887 and Roscovitine had lowest binding free energies of -150.05 kJ/mol and -113.14 kJ/mol, respectively with Cdk5/p25. Free energy decomposition demonstrated that polar energy by H-bond between the Glu81 of Cdk5 and PHA-793887 is the essential factor to make PHA-793887 highly selective towards Cdk5/p25. Overall, this study provided substantial evidences to explore mechanistic interactions of the selective inhibitors of Cdk5/p25 and could be used as fundamental considerations in the development of structure-based selective inhibitors of Cdk5/p25.

Keywords: Cdk5/p25 inhibition, molecular modeling of Cdk5/p25, PHA-793887 and roscovitine, selective inhibition of Cdk5/p25

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Authors: Zsuzsanna Schnell, Francesca Ervas

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Background: Our experimental pragmatic study confirms a basic tenet in the Relevance of theoretical views in language philosophy. It draws up a developmental trajectory of the maxims, revealing the cognitive difficulty of their interpretation, their relative place to each other, and the order they may follow in development. A central claim of the present research is that social-cognitive skills play a significant role in inferential meaning construction. Children passing the False Belief Test are significantly more successful in tasks measuring the recognition of the infringement of conversational maxims. Aims and method: We examine preschoolers' conversational and pragmatic competence in view of their mentalization skills. To do so, we use a measure of linguistic tasks containing 5 short scenarios for each Gricean maxim. We measure preschoolers’ ToM performance with a first- and second-order ToM task and compare participants’ ability to recognize the infringement of the Gricean maxims in view of their social cognitive skills. Results: Findings suggest that Theory of Mind has a predictive force of 75% concerning the ability to follow Gricean maxims efficiently. ToM proved to be a significant factor in predicting the group’s performance and success rates in 3 out of 4 maxim infringement recognition tasks: in the Quantity, Relevance and Manner conditions, but not in the Quality trial. Conclusions: Our results confirm that children’s communicative competence in social contexts requires the development of higher-order social-cognitive reasoning. They reveal the cognitive effort needed to recognize the infringement of each maxim, yielding a continuum of their cognitive difficulty and trajectory of development.

Keywords: developmental pragmatics, social cognition, preschoolers, maxim infringement, Gricean pragmatics

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Authors: A. Ibovi Mouondayi, S. Zaher, K. Nassar, S. Janani

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Introduction: Osteoarticular ultrasound has become an essential tool for the investigation and monitoring of osteoarticular pathologies for rheumatologists. It is performed in the clinic, cheap to access than other imaging technics. Important anatomical sites of inflammation in inflammatory diseases such as synovium, tendon sheath, and enthesis are easily identifiable on ultrasound. Objective: The objective of this study was to evaluate the importance of ultrasound for rheumatologists in the development of diagnoses of inflammatory rheumatism in cases of uncertain clinical presentation. Material and Methods: This is a retrospective study conducted in our department and carried out over a period of 30 months from January 2020 to June 2022. We included all patients with inflammatory arthralgia without clinical arthritis. Patients' data were collected through a patient operating system. Results: A total of 35 patients were identified, made up of 4 men and 31 women, with a sex ratio M/F of 0.12. The average age of the patients was 48.8 years, with extremes ranging from 17 years to 83 years. All patients had inflammatory polyarthralgia for an average of 9.3 years. Only two patients had suspicious synovitis on clinical examination. 91.43% of patients had a positive inflammatory assessment with an average CRP of 22.2 mg/L. Rheumatoid factor (RF) was present in 45.7% of patients and anti-CCP in 48.57%, with respective averages of 294.43 and 314.63 international units/mL. Radiographic lesions were found in 54% of patients. Osteoarticular ultrasound was performed in all these patients. Subclinical synovitis was found in 60% of patients, including 23% Doppler positive. Tenosynovitis was found in 11% of patients. Enthesitis was objectified in 3% of patients. Rheumatoid arthritis (RA) was retained in 40% of patients; psoriatic arthritis in 6% of patients, hydroxyapatite arthritis, and osteoarthritis in 3% each. Conclusion: Osteoarticular ultrasound has been an essential tool in the practice of rheumatology in recent years. It is for diagnostic purposes in chronic inflammatory rheumatism as well as in degenerative rheumatism and crystal induced arthropathies, but also essential in the follow-up of patients in rheumatology.

Keywords: ultrasound, skeletal, rheumatoid arthritis, arthralgia

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Authors: Larry Turkish

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Introduction: The NBA is an example of mediocrity and this will be evident in the following paper. The study examines and evaluates the characteristics of the NBA champions. As divisions and playoff teams increase, there is an increase in the probability that the champion originates from the mediocre category. Since it’s inception in 1947, the league has been mediocre and continues to this day. Why does a professional league allow any team with a less than 50% winning percentage into the playoffs? As long as the finances flow into the league, owners will not change the current algorithm. The objective of this paper is to determine if the regular season has meaning in finding an NBA champion. Statistical Analysis: The data originates from the NBA website. The following variables are part of the statistical analysis: Rank, the rank of a team relative to other teams in the league based on the regular season win-loss record; Winning Percentage of a team based on the regular season; Divisions, the number of divisions within the league and Playoff Teams, the number of playoff teams relative to a particular season. The following statistical applications are applied to the data: Pearson Product-Moment Correlation, Analysis of Variance, Factor and Regression analysis. Conclusion: The results indicate that the divisional structure and number of playoff teams results in a negative effect on the winning percentage of playoff teams. It also prevents teams with higher winning percentages from accessing the playoffs. Recommendations: 1. Teams that have a winning percentage greater than 1 standard deviation from the mean from the regular season will have access to playoffs. (Eliminates mediocre teams.) 2. Eliminate Divisions (Eliminates weaker teams from access to playoffs.) 3. Eliminate Conferences (Eliminates weaker teams from access to the playoffs.) 4. Have a balanced regular season schedule, (Reduces the number of regular season games, creates equilibrium, reduces bias) that will reduce the need for load management.

Keywords: alignment, mediocrity, regression, z-score

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Authors: Chiara Di Tucci, Giulia Galati, Giulia Mattei, Valentina Bonanni, Oriana Capri, Renzo D'Amelio, Ludovico Muzii, Pierluigi Benedetti Panici

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Objective: Infertility is an increasingly frequent health condition, which may depend on female or male factors. Oxidative stress (OS), resulting from a disrupted balance between reactive oxygen species (ROS) and protective antioxidants, affects the reproductive lifespan of men and women. In this review, we examine if alpha lipoic acid (ALA), among the oral supplements currently in use, has an evidence-based beneficial role in the context of female and male infertility. Methods: We performed a search from English literature using the PubMed database with the following keywords: 'female infertility', 'male infertility', 'semen', 'sperm', 'sub-fertile man', 'alpha-lipoic acid', ' alpha lipoic acid', 'lipoid acid', 'endometriosis', 'chronic pelvic pain', 'follicular fluid' and 'oocytes'. We included clinical trials, multicentric studies, and reviews. The total number of references found after automatically and manually excluding duplicates was 180. After the primary and secondary screening, 28 articles were selected. Results: The available literature demonstrates the positive effects of ALA in multiple processes, from oocyte maturation (0.87 ± 0.9% of oocyte in MII vs 0.81 ± 3.9%; p < .05) to fertilization, embryo development (57.7% vs 75.7% grade 1 embryo; p < .05) and reproductive outcomes. Its regular administration both in sub-fertile women and men has been shown to reduce pelvic pain in endometriosis (p < .05), regularize menstrual flow and metabolic disorders (p < .01), and improve sperm quality (p < .001). Conclusions: ALA represents a promising new molecule in the field of couple infertility. More clinical studies are needed in order to enhance its use in clinical practice.

Keywords: alpha lipoic acid, endometriosis, infertility, male factor, polycystic ovary syndrome

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Authors: Salman Al-Alyani

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In line with the Kingdom’s Vision 2030, the Saudi Green initiative was announced aimed at reducing carbon emissions by more than 4% of the global contribution. The initiative included plans to generate 50% of its energy from renewables by 2030. The geographical location of Saudi Arabia makes it among the best countries in terms of solar irradiation and has good wind resources in many areas across the Kingdom. Saudi Arabia is a wide country and has many remote locations where it is not economically feasible to connect those loads to the national grid. With the improvement of battery innovation and reduction in cost, different renewable technologies (primarily wind and solar) can be integrated to meet the need for energy in a more effective and cost-effective way. Saudi Arabia is famous for high solar irradiations in which solar power generation can extend up to six (6) hours per day (25% capacity factor) in some locations. However, the net present value (NPV) falls down to negative in some locations due to distance and high installation costs. Wind generation in Saudi Arabia is a promising technology. Hybrid renewable generation will increase the net present value and lower the payback time due to additional energy generated by wind. The infrastructure of the power system can be capitalized to contain solar generation and wind generation feeding the inverter, controller, and load. Storage systems can be added to support the hours that have an absence of wind or solar energy. Also, the smart controller that can help integrate various renewable technologies primarily wind and solar, to meet demand considering load characteristics. It could be scalable for grid or off-grid applications. The objective of this paper is to study the feasibility of introducing a hybrid renewable system in remote locations and the concept for the development of a smart controller.

Keywords: battery storage systems, hybrid power generation, solar energy, wind energy

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Authors: Vahab Behmanesh

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Metabolic syndrome is defined as having at least three of the five metabolic risk factors, including abdominal obesity, high blood pressure, high triglycerides, low HDL, and insulin resistance. Lifestyle changes towards reducing physical activity, unhealthy eating habits Especially the high-fat and high-carbohydrate diet is directly related to metabolic syndrome, and due to the epidemic of overweight and sedentary life, metabolic syndrome is a serious problem worldwide. On the other hand, vitamin D deficiency is considered as one of the most common problems in the world, which is related to the dysfunction of beta cells and insulin resistance, and therefore, vitamin D deficiency is considered as a factor in the occurrence of metabolic syndrome. 40 subjects (age: 16.12 ± 4.4 years and body mass index 25.61 ± 4.4 kg/m2) were randomly assigned to groups of aerobic exercise and placebo, aerobic exercise and vitamin D and placebo (no exercise) were divided. Vitamin D was taken at a dose of 50,000 units per week in a double-blind format for eight weeks, and the daily aerobic exercise program was performed for 50 to 60 minutes, three doses per week, with an intensity of 50-60% of the maximum heart rate. From one-way analysis of variance, Factorial variance analysis (2x2) repeated measurement and correlated t-test were used for data analysis. Aerobic exercise and vitamin D intake reduced all metabolic risk indicators and blood insulin (P < 0.05). However, the subjective feeling of hunger did not change significantly (P < 0.05). Regarding waist circumference and blood glucose, the effect of exercise combined with vitamin D consumption was greater than the corresponding effect in the vitamin D group (P < 0.05). Aerobic exercises and vitamin D intake are safe and effective for improving cardiometabolic health, Imam adds vitamin D to the exercise program has more benefits for weight and blood sugar control, which suggests prescribing it for patients with metabolic syndrome.

Keywords: vitamin D, aerobic exercise, metabolic control, adolescents

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Authors: Hsien Hwa Kuo, Lin Wen Chun, Lin Wen Chun, Hsien Wen Kuo

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Objective: Nurses represent an important occupational group frequently affected by wrist musculoskeletal disorders (WMSDs) due to a heavy workload, working shifts, poor posture, giving shots, making beds, lifting patients, bending their waist and insufficient rest time every day. However, lack of research reported nurses whether workload in household correlated with the severity of WMSDs. Methods: 550 nurses from a hospital in Taoyuan were interviewed using a modified standardized Nordic Musculoskeletal (NMQ) questionnaire including the demographic information, workplace condition and nine body parts of musculoskeletal disorders. Results: 17.9% and 23.9% of severity and symptoms in WMSDs among nurses with children were significant higher than among nurses without children (1​2.4% and 15.9%). Based on multiple logistic regression models adjusted for age, work duration, job title and body mass index (BMI), we found that heavy workload in hospital had higher odds ratio (OR) of the severity and symptoms of WMSD among nurses with children (OR= 8.67 and OR= 4.30, p<0.05) compared to nurses without children (OR= 1.94 and OR= 1.70). Conclusion: The severity and symptoms of WMSDs among nurses significantly correlated with workload in hospital among nurses with children. If women are at greater risk because of the combination of their work and family demands, synergistic effect of WMSDs was found among nurses. Comment: Women's domestic work, especially once they become mothers, they invest more time and energy caring for children, helping others, and doing housework. Thus domestic work, per se, may be a risk factor for wrist musculoskeletal problems, and, more importantly, it may constrain women's ability to protect themselves from the effects of their paid work. If nurses with more domestic work periodically make efforts to physical activity or modify inappropriate posture, their WMSDs symptoms will be alleviated.

Keywords: musculoskeletal disorders, nurse, NMQ, WMSDs

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Authors: Emmanuel Olugbenga Fakoya

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The study examined the perceived impact of climate change on the livelihood of arable crop farmers in Ipokia Local Government Area of Ogun State, Nigeria. Multistage sampling technique was used to select 80 arable crop farmers in the study area. Data collected were analyzed using percentages, frequencies and Chi square analysis. The result showed that 63.8 percent of the respondents were male while 55.0 percent were married. Less than half (30.0 percent) of the respondents were between the age bracket of 41-50 years and 50.0 percent had 6-10 household size. Furthermore, majority (40.0 percent) of the arable crop farmers farmed on an inherited land and 51.3 percent had 2-3 hectares of land. Majority (38.8 percent) of the farmers intercrop maize with cassava and maize with yam. Various strategies adapted to reduce the effect of climate change on their crop and livelihood include: crop rotation (53.8 percent), planting of leguminous crop (35.0 percent), application of organic fertilizers (45.0 percent), mulching (56.3 percent) and by planting drought resistance crops (46.5 percent). Reported among the effects of climate change on crop and farmers’ livelihood were: discoloration of crop leave (63.8 percent), increase infestation of pests and diseases (58.8 percent) and reduction of crop yield (60.0 percent). Chi- square analysis showed significant relationship between impact of climate change on arable crop production and thus famers’ livelihood. It was concluded from the study that climate change is an impinging factor that seriously affect arable crop production and hence farmers’ livelihood despite coping strategies to minimize its effect. It was however recommended that Agricultural policies and practices that could minimize or eliminate its effect should be seriously enacted to boost production and increase farmers’ livelihood.

Keywords: agricultural extension, extension agent, private sector, perception

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Authors: Tew Leh Ghee

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The study's goal is to determine how celebrity endorsement affects Malaysian consumers' attitudes and intentions to buy skincare products. Since customers now largely rely on celebrity endorsement to influence purchasing decisions in almost every business, celebrity endorsement is not, in reality, a new phenomenon. Even though the market for skincare products has a vast potential to be exploited, corporations have yet to seize this niche via celebrity endorsement. Basically, there hasn't been much study done to recognize the significance of celebrity endorsement in this industry. This research combined descriptive and quantitative methods with a self-administered survey as the primary data-gathering tool. All of the characteristics under study were measured using a 5-point Likert scale, and the questionnaire was written in English. A convenience sample method was used to choose respondents, and 360 sets of valid questionnaires were gathered for the study's statistical analysis. Preliminary statistical analyses were analyzed using SPSS version 20.0 (Statistical Package for the Social Sciences). The backdrop of the respondents' demographics was examined using descriptive analysis. All concept assessments' validity and reliability were examined using exploratory factor analysis, item-total statistics, and reliability statistics. Pearson correlation and regression analysis were used, respectively, to assess relationships and impacts between the variables under study. The research showed that, apart from competence, celebrity endorsements of skincare products in Malaysia had a favorable impact on attitudes and purchase intentions as evaluated by attractiveness and dependability. The research indicated that the most significant element influencing attitude and buy intention was the credibility of a celebrity endorsement. The study offered implications in order to provide potential improvements of celebrity endorsement in skincare goods in Malaysia. The study's last portion includes its limits and ideas for the future.

Keywords: trustworthiness, influential, phenomenon, celebrity emdorsement

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Authors: Simona Moravcova, Jiri Novotny, Zdenka Bendova

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The pineal gland of the vertebrate brain is a circumventricular organ which serves as a major neuroendocrine gland with the primary function of rhythmic secretion of neurohormone melatonin under the control of the hypothalamic suprachiasmatic nucleus (SCN). Soon after the onset of the darkness, the activity of the key rate-limiting enzyme for melatonin synthesis, arylalkylamine N-acetyltransferase (AANAT), raises due to the increased release of norepinephrine from sympathetic neurons terminating on the parenchymal cells where it binds to β-adrenergic receptors. Melatonin codes the length of the night, and it is well recognized for its anti-inflammatory effects. However, to our knowledge, less is known about the effect of the immune system on the melatonin biosynthesis and the precise role of the STAT3 in the signaling pathway leading to the expression of AANAT. Lipopolysaccharide (LPS) is the essential component in the outer surface membrane of gram-negative bacteria and acts as a strong stimulator of natural and innate immunity. STAT3 acts as an important factor in immune response. Here we investigated the effect of LPS on the components of the melatonergic synthetic pathway in the pineal gland. The experiments were performed both in vivo and in vitro. The changes in AANAT activity were determined by radioenzymatic assay. PCR analyses were carried out to detect aa-nat, icer, spi-3 and stat3 gene expression. From our results, it is apparent that the high basal level of phosphorylated forms of STAT3 can be elevated after systemic as well as in vitro administration of LPS. Our experiments have shown that LPS reduces melatonin synthesis, nevertheless, the activity of AANAT was increased. Moreover, the basal level of phosphorylated STAT3 counteracts β-adrenergic receptor-mediated aa-nat gene expression and sustains its own and spi-3 gene expression. In conclusion, LPS can affect immunomodulators such as melatonin in the pineal gland.

Keywords: AANAT, lipopolysaccharide, pineal gland, rat, STAT3

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Authors: Chun Hsien Wu, Guan Xuan Wu, Hsia Ying Cheng, Shyh Ming Kuo

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Articular cartilage is composed of chondrocytes and extracellular matrix, such as collagen fibers, glycosaminoglycans, etc., which play an important role in lubricating and cushion joint activities. The phenotypic expression and metabolic activity of chondrocytes are extremely important in maintaining the functions of articular cartilage. In in vitro passaged culture of chondrocytes, chondrocytes gradually lose their original cell phenotype and morphology, which is called dedifferentiation. After continuous passaged culture of chondrocytes or induction by inflammatory factor IL-1, chondrocytes changed their phenotype and morphology. Also, the extracellular matrix type II collagen and GAG secretion were significantly reduced, while type I and X collagen were synthesized. Farnesol is an anti-inflammatory and antioxidant sesquiterpene compound that has the specific property of promoting collagen production. The purpose of this study was to investigate whether farnesol could restore the original type II collagen synthesis and, furthermore, the mechanisms of farnesol on the synthesis of type II collagen from the de-differentiated chondrocytes. The obtained results showed that the de-differentiated chondrocytes significantly restored to secret type II collagen and GAG (2.5-folds increases), and the secretion of collagen I and X and PGE2 synthesis were also significantly reduced after being treated with farnesol, indicating that farnesol had a restoration/re-differentiation effect on de-differentiated chondrocytes. The de-differentiated chondrocytes exhibited decreased expression of PPAR-γ and upregulated TGF-β expression to increase the MMP-13 expression. Higher expression of MMP-13 caused chondrocytes to secret type X collagen. On the contrary, increasing the expression of PPAR-γ would benefit the production of type II collagen. As shown, the PPAR-γ expression increased, and MMP-13 expression decreased after being treated with farnesol, indicating a possible signal pathway of farnesol to restore the production of type II collagen. However, more detailed mechanisms still need to evaluate.

Keywords: chondrocytes, de-differentiation, farnesol, re-differentiation

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Authors: Eng Toon Saw, Kun Liang Ang, Wei He, Xuecheng Dong, Seeram Ramakrishna

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Solvent recovery process is receiving utmost attention in recent year due to the scarcity of natural resource and consciousness of circular economy in chemical and pharmaceutical manufacturing process. Solvent dehydration process is one of the important process to recover and to purify the solvent for reuse. Due to the complexity of solvent waste or wastewater effluent produced in pharmaceutical industry resulting the wastewater treatment process become complicated, thus an alternative solution is to recover the valuable solvent in solvent waste. To treat solvent waste and to upgrade solvent purity, membrane pervaporation process is shown to be a promising technology due to the energy intensive and low footprint advantages. Ceramic membrane is adopted as solvent dehydration membrane owing to the chemical and thermal stability properties as compared to polymeric membrane. NaA zeolite membrane is generally used as solvent dehydration process because of its narrow and distinct pore size and high hydrophilicity. NaA zeolite membrane has been mainly applied in alcohol dehydration in fermentation process. At this stage, the membrane performance exhibits high separation factor with low flux using tubular ceramic membrane. Thus, defect free and ultrathin NaA membrane should be developed to increase water flux. Herein, we report a simple preparation protocol to prepare ultrathin NaA zeolite membrane supported on tubular ceramic membrane by controlling the seed size synthesis, seeding methods and conditions, ceramic substrate surface pore size selection and secondary growth conditions. The microstructure and morphology of NaA zeolite membrane will be examined and reported. Moreover, the membrane separation performance and stability will also be reported in isopropanol dehydration, ketone dehydration and ester dehydration particularly for the application in pharmaceutical industry.

Keywords: ceramic membrane, NaA zeolite, pharmaceutical industry, solvent recovery

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Authors: Shimaa Abdel-Rahman Amin El-Badawy

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Commercial law is the set of legal rules that apply to business and regulates the trade of trade. The meaning of this is that the commercial law regulates certain relations only that arises as a result of carrying out certain businesses. which are business, as it regulates the activity of a specific sect, the sect of merchants, and the commercial law as other branches of the law has characteristics that distinguish it from other laws and various, and various sources from which its basis is derived from It is the objective or material source. the historical source, the official source and the interpretative source, and we are limited to official sources and explanatory sources. so what do you see what these sources are, and what is their degree and strength in taking it in commercial disputes. The first topic / characteristics of commercial law. Commercial law has become necessary for the world of trade and economics, which cannot be dispensed with, given the reasons that have been set as legal rules for commercial field.In fact, it is sufficient to refer to the stability and stability of the environment, and in exchange for the movement and the speed in which the commercial environment is in addition to confidence and credit. the characteristic of speed and the characteristic of trust, and credit are the ones that justify the existence of commercial law.Business is fast, while civil business is slow, stable and stability. The person concludes civil transactions in his life only a little. And before doing any civil action. he must have a period of thinking and scrutiny, and the investigation is the person who wants the husband, he must have a period of thinking and scrutiny. as if the person who wants to acquire a house to live with with his family, he must search and investigate. Discuss the price before the conclusion of a purchase contract. In the commercial field, transactions take place very quickly because the time factor has an important role in concluding deals and achieving profits. This is because the merchant in contracting about a specific deal would cause a loss to the merchant due to the linkage of the commercial law with the fluctuations of the economy and the market. The merchant may also conclude more than one deal in one and short time. And that is due to the absence of commercial law from the formalities and procedures that hinder commercial transactions.

Keywords: law, commercial law, Islamic law, custom and Islamic law

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Authors: Du Kim, Nelson Baro

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According to a report of International Atomic Energy Agency (IAEA), there are approximately 437 nuclear power stations are in operation in the present around the world in order to meet increasing energy demands. Indeed, nearly, a third of the world’s energy demands are met through nuclear power because it is one of the most efficient and long-lasting sources of energy. However, there are also consequences when a major event takes place at a nuclear power station. Over the past years, a few major nuclear accidents have occurred around the world. According to a report of International Nuclear and Radiological Event Scale (INES), there are six nuclear accidents that are considered to be high level (risk) of the events: Fukushima Dai-chi (Level 7), Chernobyl (Level 7), Three Mile Island (Level 5), Windscale (Level 5), Kyshtym (Level 6) and Chalk River (Level 5). Today, many people still have doubt about using nuclear power. There is growing number of people who are against nuclear power after the serious accident occurred at the Fukushima Dai-chi nuclear power plant in Japan. In other words, there are public concerns about radiation impacts which emphasize Linear-No-Threshold (LNT) Issues, Radiation Health Effects, Radiation Protection and Social Impacts. This paper will address those keywords by looking back at the history of these major nuclear accidents worldwide, based on INES. This paper concludes that all major mistake from nuclear accidents are preventable due to the fact that most of them are caused by human error. In other words, the human factor has played a huge role in the malfunction and occurrence of most of those events. The correct handle of a crisis is determined, by having a good radiation protection program in place, it’s what has a big impact on society and determines how acceptable people are of nuclear.

Keywords: linear-no-threshold (LNT) issues, radiation health effects, radiation protection, social impacts

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Authors: Fasil Wagnew, Kefyalew Addis Alene, Setegn Eshetie, Tom Wingfield, Matthew Kelly, Darren Gray

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Introduction: Undernutrition is a major and under-appreciated risk factor for TB, which is estimated to be responsible for 1.9 million TB cases per year globally. The effectiveness of micronutrient supplementation on TB treatment outcomes and its prognostic markers such as sputum conversion and serum zinc, retinol, and hemoglobin levels has been poorly understood. This systematic review and meta-analysis aimed to determine the association between zinc and vitamin A supplementation and TB treatment outcomes and its prognostic markers. Methods: A systematic literature search for randomized controlled trials (RCTs) was performed in PubMed, Embase, and Scopus databases. Meta-analysis with a random effect model was performed to estimate risk ratio (RR) and mean difference (MD), with a 95% confidence interval (CI), for dichotomous and continuous outcomes, respectively. Results: Our search identified 2,195 records. Of these, nine RCTs consisting of 1,375 participants were included in the final analyses. Among adults with pulmonary TB, zinc (RR: 0.94, 95%CI: 0.86, 1.03), vitamin A (RR: 0.90, 95%CI: 0.80, 1.01), and combined zinc and vitamin A (RR: 0.98, 95%CI: 0.89, 1.08) supplementation were not significantly associated with TB treatment success. Combined zinc and vitamin A supplementation was significantly associated with increased sputum smear conversion at 2 months (RR: 1.16, 95%CI: 1.03, 1.32), serum zinc levels at 2 months (MD of 0.86umol/l, 95% CI: 0.14, 1.57), serum retinol levels at 2 months (MD: 0.06umol/l, 95 % CI: 0.04, 0.08) and 6 months (MD: 0.12umol/l, 95 % CI: 0.10, 0.14), and serum hemoglobin level at 6 months (MD: 0.29 ug/dl, 95% CI: 0.08 to 0.51), among adults with TB. Conclusions: Providing zinc and vitamin A supplementation to adults with pulmonary TB during treatment may increase early sputum smear conversion, serum zinc, retinol, and hemoglobin levels. However, the use of zinc, vitamin A, or both were not associated with TB treatment success.

Keywords: zinc and vitamin A supplementation, tuberculosis, treatment outcomes, meta-analysis, RCT

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