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Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1937

Search results for: keyword search

1517 Search for EEG Correlates of Mental States Using EEG Neurofeedback Paradigm

Authors: Cyril Kaplan

Abstract:

26 participants played 4 EEG neurofeedback (NF) games encouraged to find their strategies to control the specific NF parameter. Mixed method analysis of performance in the games and post-session interviews led to the identification of states of consciousness that correlated with success in the game. We found that increase in left frontal beta activity was facilitated by evoking interest in observed surroundings, by wondering what is happening behind the window or what lies in a drawer in front.

Keywords: EEG neurofeedback, states of consciousness, frontal beta activity, mixed methods

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1516 E-Learning Platform for School Kids

Authors: Gihan Thilakarathna, Fernando Ishara, Rathnayake Yasith, Bandara A. M. R. Y.

Abstract:

E-learning is a crucial component of intelligent education. Even in the midst of a pandemic, E-learning is becoming increasingly important in the educational system. Several e-learning programs are accessible for students. Here, we decided to create an e-learning framework for children. We've found a few issues that teachers are having with their online classes. When there are numerous students in an online classroom, how does a teacher recognize a student's focus on academics and below-the-surface behaviors? Some kids are not paying attention in class, and others are napping. The teacher is unable to keep track of each and every student. Key challenge in e-learning is online exams. Because students can cheat easily during online exams. Hence there is need of exam proctoring is occurred. In here we propose an automated online exam cheating detection method using a web camera. The purpose of this project is to present an E-learning platform for math education and include games for kids as an alternative teaching method for math students. The game will be accessible via a web browser. The imagery in the game is drawn in a cartoonish style. This will help students learn math through games. Everything in this day and age is moving towards automation. However, automatic answer evaluation is only available for MCQ-based questions. As a result, the checker has a difficult time evaluating the theory solution. The current system requires more manpower and takes a long time to evaluate responses. It's also possible to mark two identical responses differently and receive two different grades. As a result, this application employs machine learning techniques to provide an automatic evaluation of subjective responses based on the keyword provided to the computer as student input, resulting in a fair distribution of marks. In addition, it will save time and manpower. We used deep learning, machine learning, image processing and natural language technologies to develop these research components.

Keywords: math, education games, e-learning platform, artificial intelligence

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1515 Clinical Efficacy of Nivolumab and Ipilimumab Combination Therapy for the Treatment of Advanced Melanoma: A Systematic Review and Meta-Analysis of Clinical Trials

Authors: Zhipeng Yan, Janice Wing-Tung Kwong, Ching-Lung Lai

Abstract:

Background: Advanced melanoma accounts for the majority of skin cancer death due to its poor prognosis. Nivolumab and ipilimumab are monoclonal antibodies targeting programmed cell death protein 1 (PD-1) and cytotoxic T-lymphocytes antigen 4 (CTLA-4). Nivolumab and ipilimumab combination therapy has been proven to be effective for advanced melanoma. This systematic review and meta-analysis are to evaluate its clinical efficacy and adverse events. Method: A systematic search was done on databases (Pubmed, Embase, Medline, Cochrane) on 21 June 2020. Search keywords were nivolumab, ipilimumab, melanoma, and randomised controlled trials. Clinical trials fulfilling the inclusion criteria were selected to evaluate the efficacy of combination therapy in terms of prolongation of progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The odd ratios and distributions of grade 3 or above adverse events were documented. Subgroup analysis was performed based on PD-L1 expression-status and BRAF-mutation status. Results: Compared with nivolumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR in combination therapy were 0.64 (95% CI, 0.48-0.85; p=0.002), 0.84 (95% CI, 0.74-0.95; p=0.007) and 1.76 (95% CI, 1.51-2.06; p < 0.001), respectively. Compared with ipilimumab monotherapy, the hazard ratios of PFS, OS and odd ratio of ORR were 0.46 (95% CI, 0.37-0.57; p < 0.001), 0.54 (95% CI, 0.48-0.61; p < 0.001) and 6.18 (95% CI, 5.19-7.36; p < 0.001), respectively. In combination therapy, the odds ratios of grade 3 or above adverse events were 4.71 (95% CI, 3.57-6.22; p < 0.001) compared with nivolumab monotherapy, and 3.44 (95% CI, 2.49-4.74; p < 0.001) compared with ipilimumab monotherapy, respectively. High PD-L1 expression level and BRAF mutation were associated with better clinical outcomes in patients receiving combination therapy. Conclusion: Combination therapy is effective for the treatment of advanced melanoma. Adverse events were common but manageable. Better clinical outcomes were observed in patients with high PD-L1 expression levels and positive BRAF-mutation.

Keywords: nivolumab, ipilimumab, advanced melanoma, systematic review, meta-analysis

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1514 A Comparative Study of the Proposed Models for the Components of the National Health Information System

Authors: M. Ahmadi, Sh. Damanabi, F. Sadoughi

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National Health Information System plays an important role in ensuring timely and reliable access to Health information which is essential for strategic and operational decisions that improve health, quality and effectiveness of health care. In other words, by using the National Health information system you can improve the quality of health data, information and knowledge used to support decision making at all levels and areas of the health sector. Since full identification of the components of this system for better planning and management influential factors of performance seems necessary, therefore, in this study, different attitudes towards components of this system are explored comparatively. Methods: This is a descriptive and comparative kind of study. The society includes printed and electronic documents containing components of the national health information system in three parts: input, process, and output. In this context, search for information using library resources and internet search were conducted and data analysis was expressed using comparative tables and qualitative data. Results: The findings showed that there are three different perspectives presenting the components of national health information system, Lippeveld, Sauerborn, and Bodart Model in 2000, Health Metrics Network (HMN) model from World Health Organization in 2008 and Gattini’s 2009 model. All three models outlined above in the input (resources and structure) require components of management and leadership, planning and design programs, supply of staff, software and hardware facilities, and equipment. In addition, in the ‘process’ section from three models, we pointed up the actions ensuring the quality of health information system and in output section, except Lippeveld Model, two other models consider information products, usage and distribution of information as components of the national health information system. Conclusion: The results showed that all the three models have had a brief discussion about the components of health information in input section. However, Lippeveld model has overlooked the components of national health information in process and output sections. Therefore, it seems that the health measurement model of network has a comprehensive presentation for the components of health system in all three sections-input, process, and output.

Keywords: National Health Information System, components of the NHIS, Lippeveld Model

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1513 Data Protection and Regulation Compliance on Handling Physical Child Abuse Scenarios- A Scoping Review

Authors: Ana Mafalda Silva, Rebeca Fontes, Ana Paula Vaz, Carla Carreira, Ana Corte-Real

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Decades of research on the topic of interpersonal violence against minors highlight five main conclusions: 1) it causes harmful effects on children's development and health; 2) it is prevalent; 3) it violates children's rights; 4) it can be prevented and 5) parents are the main aggressors. The child abuse scenario is identified through clinical observation, administrative data and self-reports. The most used instruments are self-reports; however, there are no valid and reliable self-report instruments for minors, which consist of a retrospective interpretation of the situation by the victim already in her adult phase and/or by her parents. Clinical observation and collection of information, namely from the orofacial region, are essential in the early identification of these situations. The management of medical data, such as personal data, must comply with the General Data Protection Regulation (GDPR), in Europe, and with the General Law of Data Protection (LGPD), in Brazil. This review aims to answer the question: In a situation of medical assistance to minors, in the suspicion of interpersonal violence, due to mistreatment, is it necessary for the guardians to provide consent in the registration and sharing of personal data, namely medical ones. A scoping review was carried out based on a search by the Web of Science and Pubmed search engines. Four papers and two documents from the grey literature were selected. As found, the process of identifying and signaling child abuse by the health professional, and the necessary early intervention in defense of the minor as a victim of abuse, comply with the guidelines expressed in the GDPR and LGPD. This way, the notification in maltreatment scenarios by health professionals should be a priority and there shouldn’t be the fear or anxiety of legal repercussions that stands in the way of collecting and treating the data necessary for the signaling procedure that safeguards and promotes the welfare of children living with abuse.

Keywords: child abuse, disease notifications, ethics, healthcare assistance

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1512 Examining Statistical Monitoring Approach against Traditional Monitoring Techniques in Detecting Data Anomalies during Conduct of Clinical Trials

Authors: Sheikh Omar Sillah

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Introduction: Monitoring is an important means of ensuring the smooth implementation and quality of clinical trials. For many years, traditional site monitoring approaches have been critical in detecting data errors but not optimal in identifying fabricated and implanted data as well as non-random data distributions that may significantly invalidate study results. The objective of this paper was to provide recommendations based on best statistical monitoring practices for detecting data-integrity issues suggestive of fabrication and implantation early in the study conduct to allow implementation of meaningful corrective and preventive actions. Methodology: Electronic bibliographic databases (Medline, Embase, PubMed, Scopus, and Web of Science) were used for the literature search, and both qualitative and quantitative studies were sought. Search results were uploaded into Eppi-Reviewer Software, and only publications written in the English language from 2012 were included in the review. Gray literature not considered to present reproducible methods was excluded. Results: A total of 18 peer-reviewed publications were included in the review. The publications demonstrated that traditional site monitoring techniques are not efficient in detecting data anomalies. By specifying project-specific parameters such as laboratory reference range values, visit schedules, etc., with appropriate interactive data monitoring, statistical monitoring can offer early signals of data anomalies to study teams. The review further revealed that statistical monitoring is useful to identify unusual data patterns that might be revealing issues that could impact data integrity or may potentially impact study participants' safety. However, subjective measures may not be good candidates for statistical monitoring. Conclusion: The statistical monitoring approach requires a combination of education, training, and experience sufficient to implement its principles in detecting data anomalies for the statistical aspects of a clinical trial.

Keywords: statistical monitoring, data anomalies, clinical trials, traditional monitoring

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1511 Systematic Review of Current Best Practice in the Diagnosis and Treatment of Obsessive Compulsive Disorder

Authors: Zahra R. Almansoor

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Background: Selective serotonin reuptake inhibitors (SSRI’s) and cognitive behavioural therapy (CBT) are the main treatment methods used for patients with obsessive compulsive disorder (OCD) under the National Institute of Health and Care Excellence (NICE) guidelines. Yet many patients are left with residual symptoms or remit, so several other therapeutic approaches have been explored. Objective: The objective was to systematically review the available literature regarding the treatment efficacy of current and potential approaches and diagnostic strategies. Method: First, studies were examined concerning diagnosis, prognosis, and influencing factors. Then, one reviewer conducted a systematic search of six databases using stringent search terms. Results of studies exploring the efficacy of treatment interventions were analysed and compared separately for adults and children. This review was limited to randomised controlled trials (RCT’s) conducted from 2016 onwards, and an improved Y-BOCS (Yale- Brown obsessive compulsive scale) score was the primary outcome measure. Results: Technology-based interventions including internet-based cognitive behavioural therapy (iCBT) were deemed as potentially effective. Discrepancy remains about the benefits of SSRI use past one year, but potential medication adjuncts include amantadine. Treatments such as association splitting and family and mindfulness strategies also have future potential. Conclusion: A range of potential therapies exist, either as treatment adjuncts to current interventions or as sole therapies. To further improve efficacy, it may be necessary to remodel the current NICE stepped-care model, especially regarding the potential use of lower intensity, cheaper treatments, including iCBT. Although many interventions show promise, further research is warranted to confirm this.

Keywords: family and group treatment, mindfulness strategies, novel treatment approaches, standard treatment, technology-based interventions

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1510 Use of Smartphones in 6th and 7th Grade (Elementary Schools) in Istria: Pilot Study

Authors: Maja Ruzic-Baf, Vedrana Keteles, Andrea Debeljuh

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Younger and younger children are now using a smartphone, a device which has become ‘a must have’ and the life of children would be almost ‘unthinkable’ without one. Devices are becoming lighter and lighter but offering an array of options and applications as well as the unavoidable access to the Internet, without which it would be almost unusable. Numerous features such as taking of photographs, listening to music, information search on the Internet, access to social networks, usage of some of the chatting and messaging services, are only some of the numerous features offered by ‘smart’ devices. They have replaced the alarm clock, home phone, camera, tablet and other devices. Their use and possession have become a part of the everyday image of young people. Apart from the positive aspects, the use of smartphones has also some downsides. For instance, free time was usually spent in nature, playing, doing sports or other activities enabling children an adequate psychophysiological growth and development. The greater usage of smartphones during classes to check statuses on social networks, message your friends, play online games, are just some of the possible negative aspects of their application. Considering that the age of the population using smartphones is decreasing and that smartphones are no longer ‘foreign’ to children of pre-school age (smartphones are used at home or in coffee shops or shopping centers while waiting for their parents, playing video games often inappropriate to their age), particular attention must be paid to a very sensitive group, the teenagers who almost never separate from their ‘pets’. This paper is divided into two sections, theoretical and empirical ones. The theoretical section gives an overview of the pros and cons of the usage of smartphones, while the empirical section presents the results of a research conducted in three elementary schools regarding the usage of smartphones and, specifically, their usage during classes, during breaks and to search information on the Internet, check status updates and 'likes’ on the Facebook social network.

Keywords: education, smartphone, social networks, teenagers

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1509 In Search of Good Fortune: Individualization, Youth and the Spanish Labour Market within a Context of Crisis

Authors: Matthew Lee Turnbough

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In 2007 Spain began to experience the effects of a deep economic crisis, which would generate a situation characterised by instability and uncertainty. This has been an obstacle, especially acute for the youth of this country seeking to enter the workforce. As a result of the impact of COVID-19, the youth in Spain are now suffering the effects of a new crisis that has deepened an already fragile labour environment. In this paper, we analyse the discourses that have emerged from a precarious labour market, specifically from two companies dedicated to operating job portals and job listings in Spain, Job Today, and CornerJob. These two start-up businesses have developed mobile applications geared towards young adults in search of employment in the service sector, two of the companies with the highest user rates in Spain. Utilizing a discourse analysis approach, we explore the impact of individualization and how the process of psychologization may contribute to an increasing reliance on individual solutions to social problems. As such, we seek to highlight the expectations and demands that are placed upon young workers and the type of subjectivity that this dynamic could foster, all this within an unstable framework seemingly marked by chance, a context which is key for the emergence of individualization. Furthermore, we consider the extent to which young adults incorporate these discourses and the strategies they employ basing our analysis on the VULSOCU (New Forms of Socio-Existential Vulnerability, Supports, and Care in Spain) research project, specifically the results of nineteen in-depth interviews and three discussion groups with young adults in this country. Consequently, we seek to elucidate the argumentative threads rooted in the process of individualization and underline the implications of this dynamic for the young worker and his/her labour insertion while also identifying manifestations of the goddess of fortune as a representation of chance in this context. Finally, we approach this panorama of social change in Spain from the perspective of the individuals or young adults who find themselves immersed in this transition from one crisis to another.

Keywords: chance, crisis, discourses, individualization, work, youth

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1508 Occupational Health and Safety Servicing in Turkey: A New Approach

Authors: Duygu Çelgin

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Until the new Occupational Health and Safety Law of Turkey, most of the workers were excluded from the mandatory occupational health and safety services. This new law, made the OHS services mandatory for all workers from all sectors including both public and private. However, in the application some problems and disadvantageous cases are occurred and the government also considered these cases. In this study, the new OHS law of Turkey and the regulations prepared according to the law are studied with the literature search.

Keywords: occupational health and safety in Turkey, OHS servicing in Turkey, safety experts, OHS support

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1507 The State of Oral Health after COVID-19 Lockdown: A Systematic Review

Authors: Faeze omid, Morteza Banakar

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Background: The COVID-19 pandemic has had a significant impact on global health and healthcare systems, including oral health. The lockdown measures implemented in many countries have led to changes in oral health behaviors, access to dental care, and the delivery of dental services. However, the extent of these changes and their effects on oral health outcomes remains unclear. This systematic review aims to synthesize the available evidence on the state of oral health after the COVID-19 lockdown. Methods: We conducted a systematic search of electronic databases (PubMed, Embase, Scopus, and Web of Science) and grey literature sources for studies reporting on oral health outcomes after the COVID-19 lockdown. We included studies published in English between January 2020 and March 2023. Two reviewers independently screened the titles, abstracts, and full texts of potentially relevant articles and extracted data from included studies. We used a narrative synthesis approach to summarize the findings. Results: Our search identified 23 studies from 12 countries, including cross-sectional surveys, cohort studies, and case reports. The studies reported on changes in oral health behaviors, access to dental care, and the prevalence and severity of dental conditions after the COVID-19 lockdown. Overall, the evidence suggests that the lockdown measures had a negative impact on oral health outcomes, particularly among vulnerable populations. There were decreases in dental attendance, increases in dental anxiety and fear, and changes in oral hygiene practices. Furthermore, there were increases in the incidence and severity of dental conditions, such as dental caries and periodontal disease, and delays in the diagnosis and treatment of oral cancers. Conclusion: The COVID-19 pandemic and associated lockdown measures have had significant effects on oral health outcomes, with negative impacts on oral health behaviors, access to care, and the prevalence and severity of dental conditions. These findings highlight the need for continued monitoring and interventions to address the long-term effects of the pandemic on oral health.

Keywords: COVID-19, oral health, systematic review, dental public health

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1506 Hand in Hand with Indigenous People Worldwide through the Discovery of Indigenous Entrepreneurial Models: A Systematic Literature Review of International Indigenous Entrepreneurship

Authors: Francesca Croce

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Governmental development strategies aimed at entrepreneurship as a major resource for economic development and poverty reduction of indigenous people. As initiatives and programs are local based, there is a need to better understand the contextual factors of indigenous entrepreneurial models. The purpose of this paper is, therefore, to analyze and integrated the indigenous entrepreneurship literature in order to identify the main models of indigenous entrepreneurship. To answer this need, a systematic literature review was conducted. Relevant articles were identified in selected electronic databases (ABI/Inform Global, Business Source Premier, Web of Science; International Bibliography of the Social Sciences, Academic Search, Sociological Abstract, Entrepreneurial Studies Sources and Bibliography of Native North America) and in selected electronic review. Beginning to 1st January 1995 (first International Day of the World’s Indigenous People), 59 academic articles were selected from 1411. Through systematic analysis of the cultural, social and organizational variables, the paper highlights that a typology of indigenous entrepreneurial models is possible thought the concept of entrepreneurial ecosystem, which includes the geographical position and the environment of the indigenous communities. The results show three models of indigenous entrepreneurship: the urban indigenous entrepreneurship, the semi-urban indigenous entrepreneurship, and rural indigenous entrepreneurship. After the introduction, the paper is organized as follows. In the first part theoretical and practical needs of a systematic literature review on indigenous entrepreneurship are provided. In the second part, the methodology, the selection process and evaluation of the articles are explained. In the third part, findings are presented and each indigenous entrepreneurial model characteristics are discussed. The results of this study bring a new theorization about indigenous entrepreneurship and may be useful for scientists in the field in search of overcoming the cognitive border of Indigenous business models still too little known. Also, the study is addressed to policy makers in charge of indigenous entrepreneurial development strategies more focused on contextual factors studies.

Keywords: community development, entrepreneurial ecosystem, indigenous entrepreneurship model, indigenous people, systematic literature review

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1505 Particle Swarm Optimization Based Vibration Suppression of a Piezoelectric Actuator Using Adaptive Fuzzy Sliding Mode Controller

Authors: Jin-Siang Shaw, Patricia Moya Caceres, Sheng-Xiang Xu

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This paper aims to integrate the particle swarm optimization (PSO) method with the adaptive fuzzy sliding mode controller (AFSMC) to achieve vibration attenuation in a piezoelectric actuator subject to base excitation. The piezoelectric actuator is a complicated system made of ferroelectric materials and its performance can be affected by nonlinear hysteresis loop and unknown system parameters and external disturbances. In this study, an adaptive fuzzy sliding mode controller is proposed for the vibration control of the system, because the fuzzy sliding mode controller is designed to tackle the unknown parameters and external disturbance of the system, and the adaptive algorithm is aimed for fine-tuning this controller for error converging purpose. Particle swarm optimization method is used in order to find the optimal controller parameters for the piezoelectric actuator. PSO starts with a population of random possible solutions, called particles. The particles move through the search space with dynamically adjusted speed and direction that change according to their historical behavior, allowing the values of the particles to quickly converge towards the best solutions for the proposed problem. In this paper, an initial set of controller parameters is applied to the piezoelectric actuator which is subject to resonant base excitation with large amplitude vibration. The resulting vibration suppression is about 50%. Then PSO is applied to search for an optimal controller in the neighborhood of this initial controller. The performance of the optimal fuzzy sliding mode controller found by PSO indeed improves up to 97.8% vibration attenuation. Finally, adaptive version of fuzzy sliding mode controller is adopted for further improving vibration suppression. Simulation result verifies the performance of the adaptive controller with 99.98% vibration reduction. Namely the vibration of the piezoelectric actuator subject to resonant base excitation can be completely annihilated using this PSO based adaptive fuzzy sliding mode controller.

Keywords: adaptive fuzzy sliding mode controller, particle swarm optimization, piezoelectric actuator, vibration suppression

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1504 Clinical and Microbiologic Efficacy and Safety of Imipenem Cilastatin Relebactam in Complicated Infections: A Meta-analysis

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

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

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

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1503 Autobiographical Memory Functions and Perceived Control in Depressive Symptoms among Young Adults

Authors: Meenu S. Babu, K. Jayasankara Reddy

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Depression is a serious mental health concern that leads to significant distress and dysfunction in an individual. Due to the high physical, psychological, social, and economic burden it causes, it is important to study various bio-psycho-social factors that influence the onset, course, duration, intensity of depressive symptoms. The study aims to explore relationship between autobiographical memory (AM) functions, perceived control over stressful events and depressive symptoms. AM functions and perceived control were both found to be protective factors for individuals against depression and were both modifiable to predict better behavioral and affective outcomes. An extensive review of literatur, with a systematic search on Google Scholar, JSTOR, Science Direct and Springer Journals database, was conducted for the purpose of this review paper. These were used for all the aforementioned databases. The time frame used for the search was 2010-2021. An additional search was conducted with no time bar to map the development of the theoretical concepts. The relevant studies with quantitative, qualitative, experimental, and quasi- experimental research designs were included for the review. Studies including a sample with a DSM- 5 or ICD-10 diagnosis of depressive disorders were excluded from the study to focus on the behavioral patterns in a non-clinical population. The synthesis of the findings that were obtained from the review indicates there is a significant relationship between cognitive variables of AM functions and perceived control and depressive symptoms. AM functions were found to be have significant effects on once sense of self, interpersonal relationships, decision making, self- continuity and were related to better emotion regulation and lower depressive symptoms. Not all the components of AM function were equally significant in their relationships with various depressive symptoms. While self and directive functions were more related to emotion regulation, anhedonia, motivation and hence mood and affect, the social function was related to perceived social support and social engagement. Perceived control was found to be another protective cognitive factor that provides individuals a sense of agency and control over one’s life outcomes which was found to be low in individuals with depression. This was also associated to the locus of control, competency beliefs, contingency beliefs and subjective well being in individuals and acted as protective factors against depressive symptoms. AM and perceived control over stressful events serve adaptive functions, hence it is imperative to study these variables more extensively. They can be imperative in planning and implementing therapeutic interventions to foster these cognitive protective factors to mitigate or alleviate depressive symptoms. Exploring AM as a determining factor in depressive symptoms along with perceived control over stress creates a bridge between biological and cognitive factors underlying depression and increases the scope of developing a more eclectic and effective treatment plan for individuals. As culture plays a crucial role in AM functions as well as certain aspects of control such as locus of control, it is necessary to study these variables keeping in mind the cultural context to tailor culture/community specific interventions for depression.

Keywords: autobiographical memories, autobiographical memory functions, perceived control, depressive symptoms, depression, young adults

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1502 Portfolio Risk Management Using Quantum Annealing

Authors: Thomas Doutre, Emmanuel De Meric De Bellefon

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This paper describes the application of local-search metaheuristic quantum annealing to portfolio opti- mization. Heuristic technics are particularly handy when Markowitz’ classical Mean-Variance problem is enriched with additional realistic constraints. Once tailored to the problem, computational experiments on real collected data have shown the superiority of quantum annealing over simulated annealing for this constrained optimization problem, taking advantages of quantum effects such as tunnelling.

Keywords: optimization, portfolio risk management, quantum annealing, metaheuristic

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1501 An Exploration of The Patterns of Transcendence in Indian and Hopkins’s Aesthetics

Authors: Lima Antony

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In G. M. Hopkins’s poetics and aesthetics there is scope for a comparative study with Indian discourses on aesthetics, an area not adequately explored so far. This exploration will enrich the field of comparative study of diverse cultural expressions and their areas of similarity. A comparative study of aesthetic and religious experiences in diverse cultures will open up avenues for the discovery of similarities in self-experiences and their transcendence. Such explorations will reveal similar patterns in aesthetic and religious experiences. The present paper intends to prove this in the theories of Hopkins and Indian aesthetics. From the time of the Vedas Indian sages have believed that aesthetic enjoyment could develop into a spiritual realm. From the Natyasastra of Bharata, Indian aesthetics develops and reaches its culmination in later centuries into a consciousness of union with the mystery of the Ultimate Being, especially in Dhvanaāloka of Anandavardhana and Locana of Abhinavagupta. Dhvanyaloka elaborates the original ideas of rasa (mood or flavor) and dhvani (power of suggestion) in Indian literary theory and aesthetics. Hopkins was successful, like the ancient Indian alankarikas, in creating aesthetically superb patterns at various levels of sound and sense for which he coined the term ‘inscape’. So Hopkins’s aesthetic theory becomes suitable for transcultural comparative study with Indian aesthetics especially the dhvani theories of Anandavardhana and Abhinavagupta. Hopkins’s innovative approach to poetics and his selection of themes are quite suitable for analysis in the light of Indian literary theories. Indian philosophy views the ultimate reality called Brahman, as the 'soul,' or inner essence, of all reality. We see in Hopkins also a search for the essence of things and the chiming of their individuality with the Ultimate Being in multidimensional patterns of sound, sense and ecstatic experience. This search culminates in the realization of a synthesis of the individual self with the Ultimate Being. This is achieved through an act of surrender of the individuality of the self before the Supreme Being. Attempts to reconcile the immanent and transcendent aspects of the Ultimate Being can be traced in the Indian as well as Hopkins’s aesthetics which can contribute to greater understanding and harmony between cultures.

Keywords: Dhvani, Indian aesthetics, transcultural studies, Rasa

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1500 A Qualitative Research of Online Fraud Decision-Making Process

Authors: Semire Yekta

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Many online retailers set up manual review teams to overcome the limitations of automated online fraud detection systems. This study critically examines the strategies they adapt in their decision-making process to set apart fraudulent individuals from non-fraudulent online shoppers. The study uses a mix method research approach. 32 in-depth interviews have been conducted alongside with participant observation and auto-ethnography. The study found out that all steps of the decision-making process are significantly affected by a level of subjectivity, personal understandings of online fraud, preferences and judgments and not necessarily by objectively identifiable facts. Rather clearly knowing who the fraudulent individuals are, the team members have to predict whether they think the customer might be a fraudster. Common strategies used are relying on the classification and fraud scorings in the automated fraud detection systems, weighing up arguments for and against the customer and making a decision, using cancellation to test customers’ reaction and making use of personal experiences and “the sixth sense”. The interaction in the team also plays a significant role given that some decisions turn into a group discussion. While customer data represent the basis for the decision-making, fraud management teams frequently make use of Google search and Google Maps to find out additional information about the customer and verify whether the customer is the person they claim to be. While this, on the one hand, raises ethical concerns, on the other hand, Google Street View on the address and area of the customer puts customers living in less privileged housing and areas at a higher risk of being classified as fraudsters. Phone validation is used as a final measurement to make decisions for or against the customer when previous strategies and Google Search do not suffice. However, phone validation is also characterized by individuals’ subjectivity, personal views and judgment on customer’s reaction on the phone that results in a final classification as genuine or fraudulent.

Keywords: online fraud, data mining, manual review, social construction

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1499 The Ecosystem of Food Allergy Clinical Trials: A Systematic Review

Authors: Eimar Yadir Quintero Tapias

Abstract:

Background: Science is not generally self-correcting; many clinical studies end with the same conclusion "more research is needed." This study hypothesizes that first, we need a better appraisal of the available (and unavailable) evidence instead of creating more of the same false inquiries. Methods: Systematic review of ClinicalTrials.gov study records using the following Boolean operators: (food OR nut OR milk OR egg OR shellfish OR wheat OR peanuts) AND (allergy OR allergies OR hypersensitivity OR hypersensitivities). Variables included the status of the study (e g., active and completed), availability of results, sponsor type, sample size, among others. To determine the rates of non-publication in journals indexed by PubMed, an advanced search query using the specific Number of Clinical Trials (e.g., NCT000001 OR NCT000002 OR...) was performed. As a prophylactic measure to prevent P-hacking, data analyses only included descriptive statistics and not inferential approaches. Results: A total of 2092 study records matched the search query described above (date: September 13, 2019). Most studies were interventional (n = 1770; 84.6%) and the remainder observational (n = 322; 15.4%). Universities, hospitals, and research centers sponsored over half of these investigations (n = 1208; 57.7%), 308 studies (14.7%) were industry-funded, and 147 received NIH grants; the remaining studies got mixed sponsorship. Regarding completed studies (n = 1156; 55.2%), 248 (21.5%) have results available at the registry site, and 417 (36.1%) matched NCT numbers of journal papers indexed by PubMed. Conclusions: The internal and external validity of human research is critical for the appraisal of medical evidence. It is imperative to analyze the entire dataset of clinical studies, preferably at a patient-level anonymized raw data, before rushing to conclusions with insufficient and inadequate information. Publication bias and non-registration of clinical trials limit the evaluation of the evidence concerning therapeutic interventions for food allergy, such as oral and sublingual immunotherapy, as well as any other medical condition. Over half of the food allergy human research remains unpublished.

Keywords: allergy, clinical trials, immunology, systematic reviews

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1498 Effects of Pulsed Electromagnetic and Static Magnetic Fields on Musculoskeletal Low Back Pain: A Systematic Review Approach

Authors: Mohammad Javaherian, Siamak Bashardoust Tajali, Monavvar Hadizadeh

Abstract:

Objective: This systematic review study was conducted to evaluate the effects of Pulsed Electromagnetic (PEMF) and Static Magnetic Fields (SMG) on pain relief and functional improvement in patients with musculoskeletal Low Back Pain (LBP). Methods: Seven electronic databases were searched by two researchers independently to identify the published Randomized Controlled Trials (RCTs) on the efficacy of pulsed electromagnetic, static magnetic, and therapeutic nuclear magnetic fields. The identified databases for systematic search were Ovid Medline®, Ovid Cochrane RCTs and Reviews, PubMed, Web of Science, Cochrane Library, CINAHL, and EMBASE from 1968 to February 2016. The relevant keywords were selected by Mesh. After initial search and finding relevant manuscripts, all references in selected studies were searched to identify second hand possible manuscripts. The published RCTs in English would be included to the study if they reported changes on pain and/or functional disability following application of magnetic fields on chronic musculoskeletal low back pain. All studies with surgical patients, patients with pelvic pain, and combination of other treatment techniques such as acupuncture or diathermy were excluded. The identified studies were critically appraised and the data were extracted independently by two raters (M.J and S.B.T). Probable disagreements were resolved through discussion between raters. Results: In total, 1505 abstracts were found following the initial electronic search. The abstracts were reviewed to identify potentially relevant manuscripts. Seventeen possibly appropriate studies were retrieved in full-text of which 48 were excluded after reviewing their full-texts. Ten selected articles were categorized into three subgroups: PEMF (6 articles), SMF (3 articles), and therapeutic nuclear magnetic fields (tNMF) (1 article). Since one study evaluated tNMF, we had to exclude it. In the PEMF group, one study of acute LBP did not show significant positive results and the majority of the other five studies on Chronic Low Back Pain (CLBP) indicated its efficacy on pain relief and functional improvement, but one study with the lowest sessions (6 sessions during 2 weeks) did not report a significant difference between treatment and control groups. In the SMF subgroup, two articles reported near significant pain reduction without any functional improvement although more studies are needed. Conclusion: The PEMFs with a strength of 5 to 150 G or 0.1 to 0.3 G and a frequency of 5 to 64 Hz or sweep 7 to 7KHz can be considered as an effective modality in pain relief and functional improvement in patients with chronic low back pain, but there is not enough evidence to confirm their effectiveness in acute low back pain. To achieve the appropriate effectiveness, it is suggested to perform this treatment modality 20 minutes per day for at least 9 sessions. SMFs have not been reported to be substantially effective in decreasing pain or improving the function in chronic low back pain. More studies are necessary to achieve more reliable results.

Keywords: pulsed electromagnetic field, static magnetic field, magnetotherapy, low back pain

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1497 Just Not Seeing It: Exploring the Relationship between Inattention Blindness and Banner Blindness

Authors: Carie Cunningham, Krsiten Lynch

Abstract:

Despite a viewer’s thought that they may be paying attention, many times they are missing out on their surrounds-- a phenomenon referred to as inattentional blindness. Inattention blindness refers to the failure of an individual to orient their attention to a particular item in their visual field. This well-defined in the psychology literature. Similarly, this phenomenon has been evaluated in media types in advertising. In advertising, not comprehending/remembering items in one’s field of vision is known as banner blindness. On the other hand, banner blindness is a phenomenon that occurs when individuals habitually see a banner in a specific area on a webpage, and thus condition themselves to ignore those habitual areas. Another reason that individuals avoid these habitual areas (usually on the top or sides of a webpage) is due to the lack of personal relevance or pertinent information to the viewer. Banner blindness, while a web-based concept, may also relate this inattention blindness. This paper is proposing an analysis of the true similarities and differences between these concepts bridging the two dimensions of thinking together. Forty participants participated in an eye-tracking and post-survey experiment to test attention and memory measures in both a banner blindness and inattention blindness condition. The two conditions were conducted between subjects semi-randomized order. Half of participants were told to search through the content ignoring the advertising banners; the other half of participants were first told to search through the content ignoring the distractor icon. These groups were switched after 5 trials and then 5 more trials were completed. In review of the literature, sustainability communication was found to have many inconsistencies with message production and viewer awareness. For the purpose of this study, we used advertising materials as stimuli. Results suggest that there are gaps between the two concepts and that more research should be done testing these effects in a real world setting versus an online environment. This contributes to theory by exploring the overlapping concepts—inattention blindness and banner blindness and providing the advertising industry with support that viewers can still fall victim to ignoring items in their field of view even if not consciously, which will impact message development.

Keywords: attention, banner blindness, eye movement, inattention blindness

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1496 Key Transfer Protocol Based on Non-invertible Numbers

Authors: Luis A. Lizama-Perez, Manuel J. Linares, Mauricio Lopez

Abstract:

We introduce a method to perform remote user authentication on what we call non-invertible cryptography. It exploits the fact that the multiplication of an invertible integer and a non-invertible integer in a ring Zn produces a non-invertible integer making infeasible to compute factorization. The protocol requires the smallest key size when is compared with the main public key algorithms as Diffie-Hellman, Rivest-Shamir-Adleman or Elliptic Curve Cryptography. Since we found that the unique opportunity for the eavesdropper is to mount an exhaustive search on the keys, the protocol seems to be post-quantum.

Keywords: invertible, non-invertible, ring, key transfer

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1495 From Text to Data: Sentiment Analysis of Presidential Election Political Forums

Authors: Sergio V Davalos, Alison L. Watkins

Abstract:

User generated content (UGC) such as website post has data associated with it: time of the post, gender, location, type of device, and number of words. The text entered in user generated content (UGC) can provide a valuable dimension for analysis. In this research, each user post is treated as a collection of terms (words). In addition to the number of words per post, the frequency of each term is determined by post and by the sum of occurrences in all posts. This research focuses on one specific aspect of UGC: sentiment. Sentiment analysis (SA) was applied to the content (user posts) of two sets of political forums related to the US presidential elections for 2012 and 2016. Sentiment analysis results in deriving data from the text. This enables the subsequent application of data analytic methods. The SASA (SAIL/SAI Sentiment Analyzer) model was used for sentiment analysis. The application of SASA resulted with a sentiment score for each post. Based on the sentiment scores for the posts there are significant differences between the content and sentiment of the two sets for the 2012 and 2016 presidential election forums. In the 2012 forums, 38% of the forums started with positive sentiment and 16% with negative sentiment. In the 2016 forums, 29% started with positive sentiment and 15% with negative sentiment. There also were changes in sentiment over time. For both elections as the election got closer, the cumulative sentiment score became negative. The candidate who won each election was in the more posts than the losing candidates. In the case of Trump, there were more negative posts than Clinton’s highest number of posts which were positive. KNIME topic modeling was used to derive topics from the posts. There were also changes in topics and keyword emphasis over time. Initially, the political parties were the most referenced and as the election got closer the emphasis changed to the candidates. The performance of the SASA method proved to predict sentiment better than four other methods in Sentibench. The research resulted in deriving sentiment data from text. In combination with other data, the sentiment data provided insight and discovery about user sentiment in the US presidential elections for 2012 and 2016.

Keywords: sentiment analysis, text mining, user generated content, US presidential elections

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1494 Designing and Implementing a Tourist-Guide Web Service Based on Volunteer Geographic Information Using Open-Source Technologies

Authors: Javad Sadidi, Ehsan Babaei, Hani Rezayan

Abstract:

The advent of web 2.0 gives a possibility to scale down the costs of data collection and mapping, specifically if the process is done by volunteers. Every volunteer can be thought of as a free and ubiquitous sensor to collect spatial, descriptive as well as multimedia data for tourist services. The lack of large-scale information, such as real-time climate and weather conditions, population density, and other related data, can be considered one of the important challenges in developing countries for tourists to make the best decision in terms of time and place of travel. The current research aims to design and implement a spatiotemporal web map service using volunteer-submitted data. The service acts as a tourist-guide service in which tourists can search interested places based on their requested time for travel. To design the service, three tiers of architecture, including data, logical processing, and presentation tiers, have been utilized. For implementing the service, open-source software programs, client and server-side programming languages (such as OpenLayers2, AJAX, and PHP), Geoserver as a map server, and Web Feature Service (WFS) standards have been used. The result is two distinct browser-based services, one for sending spatial, descriptive, and multimedia volunteer data and another one for tourists and local officials. Local official confirms the veracity of the volunteer-submitted information. In the tourist interface, a spatiotemporal search engine has been designed to enable tourists to find a tourist place based on province, city, and location at a specific time of interest. Implementing the tourist-guide service by this methodology causes the following: the current tourists participate in a free data collection and sharing process for future tourists, a real-time data sharing and accessing for all, avoiding a blind selection of travel destination and significantly, decreases the cost of providing such services.

Keywords: VGI, tourism, spatiotemporal, browser-based, web mapping

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1493 Optimizing the Use of Google Translate in Translation Teaching: A Case Study at Prince Sultan University

Authors: Saadia Elamin

Abstract:

The quasi-universal use of smart phones with internet connection available all the time makes it a reflex action for translation undergraduates, once they encounter the least translation problem, to turn to the freely available web resource: Google Translate. Like for other translator resources and aids, the use of Google Translate needs to be moderated in such a way that it contributes to developing translation competence. Here, instead of interfering with students’ learning by providing ready-made solutions which might not always fit into the contexts of use, it can help to consolidate the skills of analysis and transfer which students have already acquired. One way to do so is by training students to adhere to the basic principles of translation work. The most important of these is that analyzing the source text for comprehension comes first and foremost before jumping into the search for target language equivalents. Another basic principle is that certain translator aids and tools can be used for comprehension, while others are to be confined to the phase of re-expressing the meaning into the target language. The present paper reports on the experience of making a measured and reasonable use of Google Translate in translation teaching at Prince Sultan University (PSU), Riyadh. First, it traces the development that has taken place in the field of translation in this age of information technology, be it in translation teaching and translator training, or in the real-world practice of the profession. Second, it describes how, with the aim of reflecting this development onto the way translation is taught, senior students, after being trained on post-editing machine translation output, are authorized to use Google Translate in classwork and assignments. Third, the paper elaborates on the findings of this case study which has demonstrated that Google Translate, if used at the appropriate levels of training, can help to enhance students’ ability to perform different translation tasks. This help extends from the search for terms and expressions, to the tasks of drafting the target text, revising its content and finally editing it. In addition, using Google Translate in this way fosters a reflexive and critical attitude towards web resources in general, maximizing thus the benefit gained from them in preparing students to meet the requirements of the modern translation job market.

Keywords: Google Translate, post-editing machine translation output, principles of translation work, translation competence, translation teaching, translator aids and tools

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1492 A New Modification of Nonlinear Conjugate Gradient Coefficients with Global Convergence Properties

Authors: Ahmad Alhawarat, Mustafa Mamat, Mohd Rivaie, Ismail Mohd

Abstract:

Conjugate gradient method has been enormously used to solve large scale unconstrained optimization problems due to the number of iteration, memory, CPU time, and convergence property, in this paper we find a new class of nonlinear conjugate gradient coefficient with global convergence properties proved by exact line search. The numerical results for our new βK give a good result when it compared with well-known formulas.

Keywords: conjugate gradient method, conjugate gradient coefficient, global convergence

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1491 Barriers and Facilitators of Physical Activity among Adults and Older Adults from Black and Minority Ethnic Groups in the UK: A Meta-Ethnographic Study

Authors: Janet Ige, Paul Pilkington, Selena Gray, Jane Powell

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Older adults from socially disadvantaged groups and Black and Minority Ethnic (BME) groups experience a higher burden of physical inactivity. Physical inactivity among BME groups is associated with the disproportionately higher level of health inequalities. People from minority ethnic groups encounter more barriers to physical activity. However, this is not often reported. There is very limited review-level evidence on the barriers and facilitators of physical activity among older adults from BME groups in the UK. This study aims to answer the following research question: what are the barriers and facilitators of physical activity participation among adults and older adults from BME background in the UK? To address this, we conducted a review of qualitative studies investigating the barriers and opportunities for physical activity among of BME adults and older adults in the UK. Method: This study is nested in an interpretive paradigm of meta-ethnography. A structured search for published literature was conducted on 6 electronic databases (MEDLINE, PsychINFO, Cumulative Index to Nursing & Allied Health Literature, Applied Social Sciences Index and Abstracts, Cochrane Database of Systematic Reviews, Allied and Complementary Medicine) from January 2007 to July 2017. Hand searching of the reference list of publications was performed in addition to a search conducted on Google Scholar to identify grey literature. Studies were eligible provided they employed any qualitative method and included participants identified as being BME, aged 50 and above, living in any community within the UK. In total, 1036 studies were identified from the structured search for literature, 718 studies were screened by titles after duplicates were removed. On applying the inclusion and exclusion criteria, a final selection of 10 studies was considered eligible for synthesis. Quality assessment was performed using the Critical Appraisal Skills Programme tool. Logic maps were used to show the relationship between factors that impact on physical activity participation among adults and older adults Result: Six key themes emerged from the data: awareness of the links between physical activity and health, interaction, and engagement with health professionals, cultural expectations and social responsibilities, appropriate environment, religious fatalism and practical challenges. Findings also showed that the barriers and facilitators of physical activity exist at the individual, community, and socio-economic, cultural and environmental level. There was a substantial gap in research among Black African groups. Findings from the review also informed the design of an ongoing survey investigating the experience and attitude of adults from Somali backgrounds towards physical activity in the UK. Conclusion: Identifying the barriers and facilitators of physical activity among BME groups is a crucial step in addressing the widening inequality gap. Findings from this study highlight the importance of engaging local BME residents in the design of exercise facilities within the community. This will ensure that cultural and social concerns are recognized and properly addressed.

Keywords: BME, UK, meta-ethnographic, adults

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1490 Sexual Dimorphism in the Sensorial Structures of the Antenna of Thygater aethiops (Hymenoptera: Apidae) and Its Relation with Some Corporal Parameters

Authors: Wendy Carolina Gomez Ramirez, Rodulfo Ospina Torres

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Thygater aethiops is a species of solitary bee with a neotropical distribution that has been adapted to live in urban environments. This species of bee presents a marked sexual dimorphism since the males have antenna almost as long as their body different from the females that present antenna with smaller size. In this work, placoid sensilla were studied, which are structures that appear in the antenna and are involved in the detection of substances both, for reproduction and for the search of food. The aim of this study was to evaluate the differences between these sensory structures in the different sexes, for which males and females were captured. Later some body measures were taken such as fresh weight with abdomen and without it, since the weight could be modified by the stomach content; other measures were taken as the total antenna length and length of the flagellum and flagelomere. After negative imprints of the antenna were made using nail polish, the imprint was cut with a microblade and mounted onto a microscope slide. The placoid sensilla were visible on the imprint, so they were counted manually on the 100x objective lens of the optical microscope. Initially, the males presented a specific distribution pattern in two types of sensilla: trichoid and placoid, the trichoid were found aligned in the dorsal face of the antenna and the placoid were distributed along the entire antenna; that was different to the females since they did not present a distribution pattern the sensilla were randomly organized. It was obtained that the males, because they have a longer antenna, have a greater number of sensilla in relation to the females. Additionally, it was found that there was no relationship between the weight and the number of sensilla, but there was a positive relationship between the length of the antenna, the length of the flagellum and the number of sensilla. The relationship between the number of sensilla per unit area in each of the sexes was also calculated, which showed that, on average, males have 4.2 ± 0.38 sensilla per unit area and females present 2.2 ± 0.20 and likewise a significant difference between sexes. This dimorphism found may be related to the sexual behavior of the species, since it has been demonstrated that males are more adapted to the perception of substances related to reproduction than to the search of food.

Keywords: antenna, olfactory organ, sensilla, sexual dimorphism, solitary bees

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1489 Study on the Self-Location Estimate by the Evolutional Triangle Similarity Matching Using Artificial Bee Colony Algorithm

Authors: Yuji Kageyama, Shin Nagata, Tatsuya Takino, Izuru Nomura, Hiroyuki Kamata

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In previous study, technique to estimate a self-location by using a lunar image is proposed. We consider the improvement of the conventional method in consideration of FPGA implementation in this paper. Specifically, we introduce Artificial Bee Colony algorithm for reduction of search time. In addition, we use fixed point arithmetic to enable high-speed operation on FPGA.

Keywords: SLIM, Artificial Bee Colony Algorithm, location estimate, evolutional triangle similarity

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1488 Endometrial Ablation and Resection Versus Hysterectomy for Heavy Menstrual Bleeding: A Systematic Review and Meta-Analysis of Effectiveness and Complications

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

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

Keywords: menorrhagia, hysterectomy, ablation, resection

Procedia PDF Downloads 155