Search results for: comprehensive emergency care and life support

Authors: Samantha Meyerholz

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MSKCC offers patients cutting edge cancer care with the highest quality standards. However, many patients and industry members do not realize that the operations of the Immunology Histology Lab (IHC) are the backbone for carrying out this mission. The IHC lab manufactures blocks and slides containing critical tissue samples that will be read by a Pathologist to diagnose and dictate a patient’s treatment course. The lab processes 200 requests daily, leading to the generation of approximately 2,000 slides and 1,100 blocks each day. Lab material is transported through labeling, cutting, staining and sorting manufacturing stations, while being managed by multiple techs throughout the space. The quality of the stain as well as wait times associated with processing requests, is directly associated with patients receiving rapid treatments and having a wider range of care options. This project aims to improve slide request turnaround time for rush and non-rush cases, while increasing the quality of each request filled (no missing slides or poorly stained items). Rush cases are to be filled in less than 24 hours, while standard cases are allotted a 48 hour time period. Reducing turnaround times enable patients to communicate sooner with their clinical team regarding their diagnosis, ultimately leading faster treatments and potentially better outcomes. Additional project goals included streamlining tech and material workflow, while reducing waste and increasing efficiency. This project followed a DMAIC structure with emphasis on lean and ergonomic principles that could be integrated into an evolving lab culture. Load times and batching processes were analyzed using process mapping, FMEA analysis, waste analysis, engineering observation, 5S and spaghetti diagramming. Reduction of lab technician movement as well as their body position at each workstation was of top concern to pathology leadership. With new equipment being brought into the lab to carry out workflow improvements, screen and tool placement was discussed with the techs in focus groups, to reduce variation and increase comfort throughout the workspace. 5S analysis was completed in two phases in the IHC lab, helping to drive solutions that reduced rework and tech motion. The IHC lab plans to continue utilizing these techniques to further reduce the time gap between tissue analysis and cancer care.

Keywords: engineering, ergonomics, healthcare, lean

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Authors: Tebikew Yeneabat, Tefera Belachew, Muluneh Haile

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Background: Exclusive breast-feeding (EBF) is the practice of feeding only breast milk (including expressed breast milk) during the first six months and no other liquids and solid foods except medications. The time to cessation of exclusive breast-feeding, however, is different in different countries depending on different factors. Studies showed the risk of diarrhea morbidity and mortality is higher among none exclusive breast-feeding infants, common during starting other foods. However, there is no study that evaluated the time to cessation of exclusive breast-feeding in the study area. The aim of this study was to show time to cessation of EBF and its predictors among mothers of index infants less than twelve months old. Methods: We conducted a community-based cross-sectional study from February 13 to March 3, 2012 using both quantitative and qualitative methods. This study included a total of 592 mothers of index infant using multi-stage sampling method. Data were collected by using interviewer administered structured questionnaire. Bivariate and multivariate Cox regression analyses were performed. Results: Cessation of exclusive breast-feeding occurred in 392 (69.63%) cases. Among these, 224 (57.1%) happened before six months, while 145 (37.0%) and 23 (5.9%) occurred at six months and after six months of age of the index infant respectively. The median time for infants to stay on exclusive breast-feeding was 6.36 months in rural and 5.13 months in urban, and this difference was statistically significant on a Log rank (Cox-mantel) test. Maternal and paternal occupation, place of residence, postnatal counseling on exclusive breast-feeding, mode of delivery, and birth order of the index infant were significant predictors of cessation of exclusive breast-feeding. Conclusion: Providing postnatal care counseling on EBF, routine follow-up and support of those mothers having infants stressing for working mothers can bring about implementation of national strategy on infant and young child feeding.

Keywords: exclusive breastfeeding, cessation, median duration, Ankesha Guagusa Woreda

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Authors: Christina Tran, Lu Khoo, Andrea Waylen

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Introduction: The evolution of the dental consultation from paternalism to partnership has been well documented in developed Western countries. Great emphasis is now placed on the importance of empowering patients to make decisions regarding their care, obtaining informed consent, and maintaining patient privacy and confidentiality. With the majority of communication occurring non-verbally, clinicians often adopt behaviours which suggest an approachable and positive attitude. However, evidence indicates that in Asia, a paternalistic model may be favored in medicine. The power imbalance occurring in doctor-patient relationships worldwide may be exacerbated by various factors in Southeast Asia: the strong hierarchical culture, and the large education gap between doctor and patient. Further insight into this matter can be gained by observing patient-dentist communication in Cambodia. The dentist:population ratio in Cambodia is approximately 1:33,000, with rural areas remaining extremely underserviced. We have carried out an observational study of communication in a voluntary dental clinic in Cambodia with the aim of describing whether the patient-dentist relationship follows a paternalistic or patient-centred model. Method: Over a period of two weeks, two clinicians provided dental care as part of a voluntary program in two Cambodian settings: a temporary, rural clinic and a permanent clinic in Phnom Penh. The clinicians independently recorded their experiences in diaries, making observations on the verbal and non-verbal communication between patients and staff. General observations such as the clinic environment were also made. The diaries were then compared and analyzed using a thematic approach. Results: The overall themes that emerged were regarding the clinic environment, verbal communication, and non-verbal communication. Regarding the clinic environment, the rural clinic was arranged in order to easily direct patients from one dentist to another, with little emphasis on continuous patient care. There was also little consideration for patient privacy: patients were often treated in the presence of many observers, including other waiting patients. However, the permanent clinic was structured to allow greater patient privacy, with continuous patient care occurring throughout the appointment. Regarding verbal communication, there was a strongly paternalistic approach to gaining consent and giving instruction. Patients rarely asked questions regarding their treatment, with dentists doing little to encourage patient involvement. Non-verbal communication between patients and dentists was generally paternalistic, with the dentist often addressing the supine patient from above. Patients often avoided making eye-contact, which may have indicated discomfort or lack of engagement. Both adult and paediatric patients rarely raised verbal concerns regarding pain during treatment, despite displaying non-verbal signs of experiencing pain. Anxious paediatric patients were sometimes managed with physical restraint by their mothers to facilitate treatment. Conclusion: Patient-professional communication in the Cambodian dental setting was observed to be generally paternalistic in nature, although more patient-centred aspects were observed in the established, urban setting. However, it should be noted that these observations are subjective in nature, and that the patients’ actual perceptions of their communication experience were unexplored. Further observations in variety of dental settings in Cambodia are needed before any definitive conclusions can be made.

Keywords: patient-dentist communication, paternalism, patient-centered, non-verbal communication

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Authors: Benghenia Hadj Abd El Kader

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Sleep apnea events as obstructive, central, mixed or hypopnea are characterized by frequent breathing cessations or reduction in upper airflow during sleep. An advanced method for analyzing the patterning of biomedical signals to recognize obstructive sleep apnea and hypopnea is presented. In the aim to extract characteristic parameters, which will be used for classifying the above stated (obstructive, central, mixed) sleep apnea and hypopnea, the proposed method is based first on the analysis of polysomnography signals such as electrocardiogram signal (ECG) and electromyogram (EMG), then classification of the (obstructive, central, mixed) sleep apnea and hypopnea. The analysis is carried out using the wavelet transform technique in order to extract characteristic parameters whereas classification is carried out by applying the SVM (support vector machine) technique. The obtained results show good recognition rates using characteristic parameters.

Keywords: obstructive, central, mixed, sleep apnea, hypopnea, ECG, EMG, wavelet transform, SVM classifier

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Authors: T. Ahilan, V. Aswin Adityan, S. Kailash

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UAV’s are small remote operated or automated aerial surveillance systems without a human pilot aboard. UAV’s generally finds its use in military and special operation application, a recent growing trend in UAV’s finds its application in several civil and non military works such as inspection of power or pipelines. The objective of this paper is the augmentation of a UAV in order to replace the existing expensive sonar (sound navigation and ranging) based equipment amongst small scale fisherman, for whom access to sonar equipment are restricted due to limited economic resources. The surveillance equipment’s present in the UAV will relay data and GPS location onto a receiver on the fishing boat using RF signals, using which the location of the schools of fishes can be found. In addition to this, an emergency beacon system is present for rescue operations and drone recovery.

Keywords: UAV, Surveillance, RF signals, fishing, sonar, GPS, video stream, school of fish

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Authors: J. J. Mathew

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Pulmonary tuberculosis is highly prevalent in the Indian subcontinent. Most cases of pulmonary tuberculosis are diagnosed with sputum examinations and the vast majority of these are undertaken by the government run establishments. However, mycobacterial cultures are not routinely done, unless drug resistance is detected based on clinical response. Modern diagnostic tests like bronchoscopy and Genexpert are not routinely employed in the government institutions for the diagnosis of pulmonary tuberculosis, but have been accepted widely by good private institutions. The utility of these investigations in the private sector is not yet well recognized. This retrospective study aims to assess the usefulness of bronchoscopy and Genexpert in the diagnosis of pulmonary tuberculosis in quaternary care private hospital in India. 30 patients with respiratory symptoms raising the possibility of tuberculosis based on clinical and radiological features, but without any significant sputum production, were subject to bronchoscopy and BAL samples taken for microbiological studies, including Genexpert. 6 out of the 30 patients were found to be Genexpert positive and none of them showed Rifampicin resistance. All the 6 cases had upper zone predominant disease. One of the 6 cases of tuberculosis had another co-existent bacterial infection according to the routine culture studies. 6 other cases were proven to be due to other bacterial infections alone, 2 had a malignant diagnosis and the remaining cases were thought to be non-infective pathologies. The Genexpert results were made available within 48 hours in the 6 positive cases. All of them were commenced on standard anti-tuberculous regimen with excellent clinical response. The other infective cases were also managed successfully based on the drug susceptibilities. The study has shown the usefulness of these investigations as early intervention enabled diagnosis facilitating treatment and prevention of any clinical deterioration. The study lends support to early bronchoscopy and Genexpert testing in suspected cases of pulmonary tuberculosis without significant sputum production, in a high prevalence country which normally relies on sputum examination for the diagnosis of pulmonary tuberculosis.

Keywords: pulmonary, tuberculosis, bronchoscopy, genexpert

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Authors: Norfiza Ibrahim, Norshuhada Shiratuddin, Siti Mahfuzah Sarif

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Decision-making system is used to facilitate people in making the right choice for their important daily activities. For the youth, proper guidance in making important decisions is needed. Their skills in decision-making aid decisions will indirectly affect their future. For that reason, this study focuses on the intelligent aspects in the development of intelligent decision support application. The aid apparently integrates Personality Traits (PT) and Multiple Intelligence (MI) data in development of a computerized personal decision aid for youth named as Youth Personal Decision Aid (Youth PDA). This study is concerned with the aid’s helpfulness based on the hybrid intelligent process. There are four main items involved which are reliability, decision making effort, confidence, as well as decision process awareness. Survey method was applied to the actual user of this system, namely the school and the Institute of Higher Education (IPT)’s students. An establish instrument was used to evaluate the study. The results of the analysis and findings in the assessment indicates a high mean value of the four dimensions in helping Youth PDA to be accepted as a useful tool for the youth in decision-making.

Keywords: decision support, multiple intelligent, personality traits, youth personal decision aid

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Authors: Rigas Kotsakis, Nikolaos Tsigilis, Vasilis Grammatikopoulos, Evridiki Zachopoulou

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During the last decade, Greece has faced an unprecedented financial crisis, affecting various aspects and functionalities of Higher Education. Besides the restricted funding of academic institutions, the students and their families encountered economical difficulties that undoubtedly influenced the effective completion of their studies. In this context, a fairly large number of students in Alexander campus of International Hellenic University (IHU) delay, interrupt, or even abandon their studies, especially when they come from low-income families, belong to sensitive social or special needs groups, they have different cultural origins, etc. For this reason, a European project, named “Umbrella”, was initiated aiming at providing the necessary psychological support and counseling, especially to disadvantaged students, towards the completion of their studies. To this end, a network of various academic members (academic staff and students) from IHU, namely iMentor, were implicated in different roles. Specifically, experienced academic staff trained students to serve as intermediate links for the integration and educational support of students that fall into the aforementioned sensitive social groups and face problems for the completion of their studies. The main idea of the project is held upon its person-centered character, which facilitates direct student-to-student communication without the intervention of the teaching staff. The backbone of the iMentors network are senior students that face no problem in their academic life and volunteered for this project. It should be noted that there is a provision from the Umbrella structure for substantial and ethical rewards for their engagement. In this context, a well-defined, stringent methodology was implemented for the evaluation of the extent of the problem in IHU and the detection of the profile of the “candidate” disadvantaged students. The first phase included two steps, (a) data collection and (b) data cleansing/ preprocessing. The first step involved the data collection process from the Secretary Services of all Schools in IHU, from 1980 to 2019, which resulted in 96.418 records. The data set included the School name, the semester of studies, a student enrolling criteria, the nationality, the graduation year or the current, up-to-date academic state (still studying, delayed, dropped off, etc.). The second step of the employed methodology involved the data cleansing/preprocessing because of the existence of “noisy” data, missing and erroneous values, etc. Furthermore, several assumptions and grouping actions were imposed to achieve data homogeneity and an easy-to-interpret subsequent statistical analysis. Specifically, the duration of 40 years recording was limited to the last 15 years (2004-2019). In 2004 the Greek Technological Institutions were evolved into Higher Education Universities, leading into a stable and unified frame of graduate studies. In addition, the data concerning active students were excluded from the analysis since the initial processing effort was focused on the detection of factors/variables that differentiated graduate and deleted students. The final working dataset included 21.432 records with only two categories of students, those that have a degree and those who abandoned their studies. Findings of the first phase are presented across faculties and further discussed.

Keywords: higher education, students support, economic crisis, mentoring

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Authors: Monir Ahmed

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This paper aims at discussing transcendence, spirituality, and well-being in light of the psychology of religion and spirituality. The main purpose of this paper is i) to demonstrate the importance of cognitive psychological process (thoughts, faith, and beliefs) and the doctrine of creation (‘creatio ex nihilo’) in transcendence, spirituality, and well-being; ii) to discuss the relationships among transcendence, spirituality, and well-being. Psychological studies of spiritual and religious phenomena have been advanced in the decade, mainly to understand how faith, spiritual and religious rituals influence or contribute to well-being. Psychologists of religion and spirituality have put forward methods, tools, and approaches necessary for promoting well-being. For instance, Kenneth I. Pargament, an American psychologist of religion and spirituality, developed spiritually integrated psychotherapy for clinical practice in dealing with the spiritual and religious issues affecting well-being. However, not much progress has been made in understanding the ability of transcendence and how such ability influences spirituality and religion as well as well-being. A possible reason could be that well-being has only been understood in a spiritual and religious context. It appears that transcendence, the core element of spirituality and religion, has not been explored adequately for well-being. In other words, the approaches that have been used so far for spirituality, religion, and well-being lack an integrated approach combining theology and psychology. The author of this paper proposes that cognitive-theological understanding involving faith and belief about the creation and the creator, the transcendent God is likely to offer a comprehensive understanding of transcendence as well as spirituality, religion, and their relationships with well-being. The importance of transcendence and the integration of psychology and theology can advance our knowledge of transcendence, spirituality, and well-being. It is inevitable that the creation is contingent and that the ultimate origin, source of the contingent physical reality, is a non-contingent being, the divine creator. As such, it is not unreasonable for many individuals to believe that the source of existence of non-contingent being, although undiscoverable in physical reality but transcendentally exists. ‘Creatio ex nihilo’ is the most fundamental doctrine in the Abrahamic faiths, i.e., Judaism, Christianity and Islam, and is widely accepted scriptural and philosophical background about the creation, creator, the divine that God created the universe out of nothing. Therefore, it is crucial to integrate theology, i.e., ‘creatio ex nihilo’ doctrine and psychology for a comprehensive understanding of transcendence, spirituality and their relationships with well-being.

Keywords: transcendence, spirituality, well-being, ‘creatio ex nihilo’ doctrine

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Authors: Anastasia Tsakiridi

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Geographic information systems (GIS) have been utilized in numerous spatial problems, such as site research, land suitability, and demographic analysis. Besides, GIS has been applied in scientific fields like geography, health, and economics. In business studies, GIS has been used to provide insights and spatial perspectives in demographic trends, spending indicators, and network analysis. To date, the information regarding the available usages of GIS in supply chain management (SCM) and how these analyses can benefit businesses is limited. A systematic literature review (SLR) of the last 5-year peer-reviewed academic literature was conducted, aiming to explore the existing usages of GIS in SCM. The searches were performed in 3 databases (Web of Science, ProQuest, and Business Source Premier) and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. The analysis resulted in 79 papers. The results indicate that the existing GIS applications used in SCM were in the following domains: a) network/ transportation analysis (in 53 of the papers), b) location – allocation site search/ selection (multiple-criteria decision analysis) (in 45 papers), c) spatial analysis (demographic or physical) (in 34 papers), d) combination of GIS and supply chain/network optimization tools (in 32 papers), and e) visualization/ monitoring or building information modeling applications (in 8 papers). An additional categorization of the literature was conducted by examining the usage of GIS in the supply chain (SC) by the business sectors, as indicated by the volume of the papers. The results showed that GIS is mainly being applied in the SC of the biomass biofuel/wood industry (33 papers). Other industries that are currently utilizing GIS in their SC were the logistics industry (22 papers), the humanitarian/emergency/health care sector (10 papers), the food/agro-industry sector (5 papers), the petroleum/ coal/ shale gas sector (3 papers), the faecal sludge sector (2 papers), the recycle and product footprint industry (2 papers), and the construction sector (2 papers). The results were also presented by the geography of the included studies and the GIS software used to provide critical business insights and suggestions for future research. The results showed that research case studies of GIS in SCM were conducted in 26 countries (mainly in the USA) and that the most prominent GIS software provider was the Environmental Systems Research Institute’s ArcGIS (in 51 of the papers). This study is a systematic literature review of the usage of GIS in SCM. The results showed that the GIS capabilities could offer substantial benefits in SCM decision-making by providing key insights to cost minimization, supplier selection, facility location, SC network configuration, and asset management. However, as presented in the results, only eight industries/sectors are currently using GIS in their SCM activities. These findings may offer essential tools to SC managers who seek to optimize the SC activities and/or minimize logistic costs and to consultants and business owners that want to make strategic SC decisions. Furthermore, the findings may be of interest to researchers aiming to investigate unexplored research areas where GIS may improve SCM.

Keywords: supply chain management, logistics, systematic literature review, GIS

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Authors: Ahmad Saad, Shuja Abbas, Breanna Marine

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Introduction: This study explores the potential applications of autologous pedal fat pad grafting as a minimally invasive therapeutic strategy for addressing pedal fat pad loss. Without adequate shock absorbing tissue, a patient can experience functional deficits, ulcerations, loss of quality of life, and significant limitations with ambulation. This study details a novel technique involving autologous adipose grafting from the abdomen to enhance plantar fat pad thickness in a patient involved in a severe motor vehicle accident which resulted in total fat pad loss of the heel. Autologous adipose grafting (AAG) was used following adipose allografting in an effort to recreate a normal shock absorbing surface to allow return to activities of daily living and painless ambulation. Methods: A 46-year-old male sustained multiple open pedal fractures and necrosis to the heel fat pad after a motorcycle accident, which resulted in complete loss of the calcaneal fat pad. The patient underwent serial debridement’s, utilization of wound vac therapy and split thickness skin grafting to accomplish complete closure, despite complete loss of adipose to area. Patient presented with complaints of pain on ambulation, inability to bear weight on the heel, recurrent ulcerations, admitted had not been ambulating for two years. Clinical exam demonstrated complete loss of the plantar fat pad with a thin layer of epithelial tissue overlying the calcaneal bone, allowing visibility of the osseous contour of the calcaneus. Scar tissue had formed in place of the fat pad, with thickened epithelial tissue extending from the midfoot to the calcaneus. After conservative measures were exhausted, the patient opted for initial management by adipose allograft matrix (AAM) injections. Post operative X-ray imaging revealed noticeable improvement in calcaneal fat pad thickness. At 1 year follow up, the patient was able to ambulate without assistive devices. The fat pad at this point was significantly thicker than it was pre-operatively, but the thickness did not restore to pre-accident thickness. In order to compare the take of allograft versus autografting of adipose tissue, the decision to use adipose autograft through abdominal liposuction harvesting was deemed suitable. A general surgeon completed harvesting of adipose cells from the patient’s abdomen via liposuction, and a podiatric surgeon performed the AAG injection into the heel. Total of 15 cc’s of autologous adipose tissue injected to the calcaneus. Results: There was a visual increase in the calcaneal fat pad thickness both clinically and radiographically. At the 6-week follow up, imaging revealed retention of the calcaneal fat pad thickness. Three months postop, patient returned to activities of daily living and increased quality of life due to their increased ability to ambulate. Discussion: AAG is a novel treatment for pedal fat pad loss. These treatments may be viable and reproducible therapeutic choices for patients suffering from fat pad atrophy, fat pad loss, and/or plantar ulcerations. Both treatments of AAM and AAG exhibited similar therapeutic results by providing pain relief for ambulation and allowing for patients to return to their quality of life.

Keywords: podiatry, wound, adipose, allograft, autograft, wound care, limb reconstruction, injection, limb salvage

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Authors: Pei Chi Fang, Wei Chen Lin

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Trichomonas tenax is a microaerophilic oral protozoan found in patients with poor oral hygiene. It participates in the inflammatory process of periodontal disease and can potentially be aspirated into the lungs, giving rise to pulmonary trichomoniasis. However, the precise roles of T. tenax in the pulmonary system remain largely unexplored and warrant comprehensive epidemiological investigation. To assess the prevalence of T. tenax infection, we collected bronchoalveolar lavage fluid (BALF) samples from hospitalized patients with lung diseases. A specific nested PCR approach was employed to determine prevalence rates, yielding 21 positive cases out of 61 samples from Ditmanson Medical Foundation Chia-Yi Christian Hospital, and 11 positive cases out of 55 samples from National Cheng Kung University Hospital. Furthermore, there is a critical need for comprehensive data regarding the presence of T. tenax in environmental surface watersheds. In this context, we present findings from investigations in the Yanshuei and Donggang river basins in southern Taiwan, which are crucial sources for public drinking water in the region. In order to elucidate potential implications on pulmonary virus infections, we conducted an analysis of gene expression level changes in H292 cell line after exposure to T. tenax. Our findings revealed significant regulation of multiple virus-related genes, including IFI44L and IFITM3. Ongoing research endeavors are focused on identifying the key components within T. tenax responsible for these observed effects. Crucially, this study lays the groundwork for a preliminary understanding of T. tenax prevalence in patients with pulmonary diseases. It also seeks to establish a meaningful correlation between lung infections and oral hygiene practices, with the ultimate aim of informing distinct treatment and prevention strategies.

Keywords: parasitology, genes, virus, human health, infection, lung

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Authors: Stephanie Duval

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The concept of educational success, combined with the overall development of the child in kindergarten, is at the center of current interests, both in research and in the environments responsible for the education of young children. In order to promote it, researchers emphasize the importance of studying the executive functions [EF] of children in preschool education. More precisely, the EFs, which refers to working memory [WM], inhibition, mental flexibility and planning, would be the pivotal element of the child’s educational success. In order to support the EFs of the child, and even his educational success, the quality of the environments is beginning to be explored more and more. The question that arises now is how to promote EFs for young children in the educational environment, in order to support their educational success? The objective of this study is to investigate the link between the quality of interactions in 5-year-old kindergarten and child’s EFs. The sample consists of 118 children (70 girls, 48 boys) in 12 classes. The quality of the interactions is observed from the Classroom Assessment Scoring System [CLASS], and the EFs (i.e., working memory, inhibition, cognitive flexibility, and planning) are measured with administered tests. The hypothesis of this study was that the quality of teacher-child interactions in preschool education, as measured by the CLASS, was associated with the child’s EFs. The results revealed that the quality of emotional support offered by adults in kindergarten, included in the CLASS tool, was positively and significantly related to WM and inhibition skills. The results also suggest that WM is a key skill in the development of EFs, which may be associated with the educational success of the child. However, this hypothesis remains to be clarified, as is the link with educational success. In addition, results showed that factors associated to the family (ex. parents’ income) moderate the relationship between the domain ‘instructional support’ of the CLASS (ex. concept development) and child’s WM skills. These data suggest a moderating effect related to family characteristics in the link between ‘quality of classroom interactions’ and ‘EFs’. This project proposes, as a future avenue, to check the distinctive effect of different environments (familial and educational) on the child’s EFs. More specifically, future study could examine the influence of the educational environment on EF skills, as well as whether or not there is a moderating effect of the family environment (ex. parents' income) on the link between the quality of the interactions in the classroom and the EFs of the children, as anticipated by this research.

Keywords: executive functions [EFs], environmental factors, quality of interactions, preschool education

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Authors: Parastou Kharazmi

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Degradation of building materials particularly pipelines causes environmental damage during renovation or replacement and is a time consuming and costly process. Rehabilitation by polymer composites is a solution for renovation of degraded pipeline in heritage buildings and other structures which are less costly, faster and causes less damage to the environment; however, it is still not clear for how long these materials can perform as expected in the field and working condition. To study their service life, two types of composites based on Epoxy and Polyester resins have been evaluated by accelerated exposure and field exposure. The primary degradation agent used in accelerated exposure has been cycling temperature with half of the tests performed in presence of water. Thin films of materials used in accelerated testing were prepared in laboratory by using the same amount of material as well as technique of multi-layers application used in majority of the field installations. Extreme intensity levels of degradation agents have been used only to evaluate materials properties and as also mentioned in ISO 15686, are not directly correlated with degradation mechanisms that would be experienced in service. In the field exposure study, the focus has been to identify possible failure modes, causes, and effects. In field exposure, it has been observed that there are other degradation agents present which can be investigated further such as presence of contaminants and rust before application which prevents formation of a uniform layer of polymer or incompatibility between dissimilar materials. This part of the study also highlighted the importance of application’s quality of the materials in the field for providing the expected performance and service life. Results from extended accelerated exposure and field exposure can help in choosing inspection techniques, establishing the primary degradation agents and can be used for ageing exposure programs with clarifying relationship between different exposure periods and sites.

Keywords: building, renovation, service life, pipelines

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Authors: Issamaldin Mohammed, Ahmed Abdalla, Hatim Elobied

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Soil erosion is globally known for adverse effects on social, environmental and economical aspects which directly or indirectly influence the human life. The area under study suffers from problems like water quality, river and agricultural canals bed rise due to high sediment load brought by Algash River from upstream (Eritrea high land), the current study utilized from remote sensing and Geographical Information System (GIS) to estimate the annual soil loss using Universal Soil Loss Equation (USLE). The USLE is widely used over the world which basically relies on rainfall erosivity factor (R), soil erodibility factor (K), topographic factor (LS), cover management factor (C) and support practice factor (P). The result of the study showed high soil loss in the study area, this result was illustrated in a form of map presenting the spatial distribution of soil loss amounts which classified into seven zones ranging from very slight zone (less than 2 ton/ha.year) to very severe (100-500 ton/ha.year), also the total soil loss from the whole study area was found to be 32,916,840.87 ton/ha.year. These kinds of results will help the experts of land management to give a priority for the severely affected zones to be tackled in an appropriate way.

Keywords: Geographical Information System, remote sensing, sedimentation, soil loss

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Authors: Megan E. Davies

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As substance use become an increasing prevalent occurrence amongst young people, prevention programs designed specifically for children and adolescents are required to protect against associated cognitive, psychological, and behavioural issues. Further, young people from marginalized backgrounds would highly benefit from culturally adapted substance use prevention programs. The first and second phase of the Life Skills Training (LST) program, the Maskwacis Life Skills Training (MLST) program, the Bii-Zin-Da-De-Da (BZDDD; “Listening to One Another”), and a culturally sensitive smoking prevention program, all of which have been adapted to Canadian Indigenous cultures and are applied within the school and family settings, are discussed. Additionally, comorbid disorders, at-risk personality types, and motivating factors associated with substance use amongst Canadian children and adolescents, specifically Indigenous youth, are explored through the application of a biopsychosocial model. Requital efforts being made in Canada towards Indigenous communities are described within a historical context, and substance use prevention programs targeting Indigenous children and adolescents are compared. Through this lens, suggestions are presented for future research on preventative interventions directed towards substance use within minority groups.

Keywords: early intervention, cultural appropriateness, life skills training, smoking prevention, drug and alcohol prevention

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Authors: Amine Ben Slama, Aymen Mouelhi, Sondes Manoubi, Chiraz Mbarek, Hedi Trabelsi, Mounir Sayadi, Farhat Fnaiech

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Vertigo is a sensation of feeling off balance; the cause of this symptom is very difficult to interpret and needs a complementary exam. Generally, vertigo is caused by an ear problem. Some of the most common causes include: benign paroxysmal positional vertigo (BPPV), Meniere's disease and vestibular neuritis (VN). In clinical practice, different tests of videonystagmographic (VNG) technique are used to detect the presence of vestibular neuritis (VN). The topographical diagnosis of this disease presents a large diversity in its characteristics that confirm a mixture of problems for usual etiological analysis methods. In this study, a vestibular neuritis analysis method is proposed with videonystagmography (VNG) applications using an estimation of pupil movements in the case of an uncontrolled motion to obtain an efficient and reliable diagnosis results. First, an estimation of the pupil displacement vectors using with Hough Transform (HT) is performed to approximate the location of pupil region. Then, temporal and frequency features are computed from the rotation angle variation of the pupil motion. Finally, optimized features are selected using Fisher criterion evaluation for discrimination and classification of the VN disease.Experimental results are analyzed using two categories: normal and pathologic. By classifying the reduced features using the Support Vector Machine (SVM), 94% is achieved as classification accuracy. Compared to recent studies, the proposed expert system is extremely helpful and highly effective to resolve the problem of VNG analysis and provide an accurate diagnostic for medical devices.

Keywords: nystagmus, vestibular neuritis, videonystagmographic system, VNG, Fisher criterion, support vector machine, SVM

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Authors: R. R. Ramsheeja, R. Sreeraj

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For view the internal structures of the human body such as liver, brain, kidney etc have a wide range of different modalities for medical images are provided nowadays. Computer Tomography is one of the most significant medical image modalities. In this paper use CT liver images for study the use of automatic computer aided techniques to calculate the volume of the liver tumor. Segmentation method is used for the detection of tumor from the CT scan is proposed. Gaussian filter is used for denoising the liver image and Adaptive Thresholding algorithm is used for segmentation. Multiple Region Of Interest(ROI) based method that may help to characteristic the feature different. It provides a significant impact on classification performance. Due to the characteristic of liver tumor lesion, inherent difficulties appear selective. For a better performance, a novel proposed system is introduced. Multiple ROI based feature selection and classification are performed. In order to obtain of relevant features for Support Vector Machine(SVM) classifier is important for better generalization performance. The proposed system helps to improve the better classification performance, reason in which we can see a significant reduction of features is used. The diagnosis of liver cancer from the computer tomography images is very difficult in nature. Early detection of liver tumor is very helpful to save the human life.

Keywords: computed tomography (CT), multiple region of interest(ROI), feature values, segmentation, SVM classification

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Authors: Gulcin Satir, Ahmet Yildirim

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Globally, including Turkey, health problems associated with malnutrition and nutrient deficiencies in childhood will remain major public health problems in future. Nutrition is a major environmental influence on physical and mental growth and development in early life. Many studies support the fact that nutritional knowledge makes contribution to wellbeing of children and their school performance. The purpose of this study was to examine nutritional knowledge and eating habits of primary school children and to investigate differences in these variables by socioeconomic status. A quasi-experimental one group pretest/posttest design study was conducted in five primary schools totaling 200 children aging 9-10 years in grade 4 to determine the effect of nutritional awareness programme on eating habits of primary school children. The schools were chosen according to parents’ social and demographic characteristics. The implemented nutritional awareness education programme focused on healthy lifestyle such as beneficial foods, eating habits, personal hygiene, physical activity and the programme consisted of eight lessons. The teaching approaches used included interactive teaching, role-playing, demonstration, small group discussions, questioning, and feedback. The lessons were given twice a week for four weeks totaling eight lessons. All lessons lasted 45-60 minutes and first 5 minutes of this was pre-assessment and last 5 minutes post assessment evaluation. The obtained data were analyzed for normality, and the distribution of the variables was tested by the Kolmogorov-Smirnov test. Paired t-test was used to evaluate the effectiveness of education programme and to compare the above-mentioned variables in each school separately before and after the lessons. The result of the paired t-test conducted separately for each school showed that on average after eight lessons, there was a 25-32% increase in nutritional knowledge of students regardless of the school they attend to and this rate was significant (P < 0.01). This shows that increase in nutritional awareness in these five schools having different socio-economic status was similar to each other. This study suggests that having children involved directly in lessons help to achieve nutritional awareness leading to healthy eating habits. It is concluded that nutritional awareness is a valuable tool to change eating habits. Study findings will provide information for developing nutrition education programmes for the healthy life and obesity prevention in children.

Keywords: children, nutritional awareness, obesity, socioeconomic status

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Authors: Triano Nurhikmat

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Along with the progress of science and technology, the development of the industrialized world in Indonesia took place very rapidly. This leads to a process of industrialization of society Indonesia faster with the establishment of the company and the workplace are diverse. Development of the industry relates to the activity of the worker. Where in these work activities do not cover the possibility of an impending crash on either the workers or on a construction project. The cause of the occurrence of industrial accidents was the fault of electrical damage, work procedures, and error technique. The method of an association rule is one of the main techniques in data mining and is the most common form used in finding the patterns of data collection. In this research would like to know how relations of the association between the incidence of any industrial accidents. Therefore, by using methods of analysis association rule patterns associated with combination obtained two iterations item set (2 large item set) when every factor of industrial accidents with a West Jakarta so industrial accidents caused by the occurrence of an electrical value damage = 0.2 support and confidence value = 1, and the reverse pattern with value = 0.2 support and confidence = 0.75.

Keywords: association rule, data mining, industrial accidents, rules

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Authors: César Coelho, Nikolai Wiegand

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The advancement of nanosatellite technology has opened new avenues for cost-effective and faster space missions. The NanoSat MO Framework (NMF) from the European Space Agency (ESA) provides a modular and simpler approach to the development of flight software and operations of small satellites. This paper presents a methodology using the NMF together with Docker for simulating constellations of satellites. By leveraging Docker containers, the software environment of individual satellites can be easily replicated within a simulated constellation. This containerized approach allows for rapid deployment, isolation, and management of satellite instances, facilitating comprehensive testing and development in a controlled setting. By integrating the NMF lightweight simulator in the container, a comprehensive simulation environment was achieved. A significant advantage of using Docker containers is their inherent scalability, enabling the simulation of hundreds or even thousands of satellites with minimal overhead. Docker's lightweight nature ensures efficient resource utilization, allowing for deployment on a single host or across a cluster of hosts. This capability is crucial for large-scale simulations, such as in the case of mega-constellations, where multiple traditional virtual machines would be impractical due to their higher resource demands. This ability for easy horizontal scaling based on the number of simulated satellites provides tremendous flexibility to different mission scenarios. Our results demonstrate that leveraging Docker containers with the NanoSat MO Framework provides a highly efficient and scalable solution for simulating satellite constellations, offering not only significant benefits in terms of resource utilization and operational flexibility but also enabling testing and validation of ground software for constellations. The findings underscore the importance of taking advantage of already existing technologies in computer science to create new solutions for future satellite constellations in space.

Keywords: containerization, docker containers, NanoSat MO framework, satellite constellation simulation, scalability, small satellites

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Authors: Zahra Asgharpour, Eric Renteria, Sebastian De Boodt

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There is a growing trend towards personalization of medical care, as evidenced by the emphasis on outcomes based medicine, the latest developments in CT and MR imaging and personalized treatment in a variety of surgical disciplines. 3D Printing has been introduced and applied in the medical field since 2000. The first applications were in the field of dental implants and custom prosthetics. According to recent publications, 3D printing in the medical field has been used in a wide range of applications which can be organized into several categories including implants, prosthetics, anatomical models and tissue bioprinting. Some of these categories are still in their infancy stage of the concept of proof while others are in application phase such as the design and manufacturing of customized implants and prosthesis. The approach of 3D printing in this category has been successfully used in the health care sector to make both standard and complex implants within a reasonable amount of time. In this study, some of the clinical applications of 3D printing in design and manufacturing of a patient-specific hip implant would be explained. In cases where patients have complex bone geometries or are undergoing a complex revision on hip replacement, the traditional surgical methods are not efficient, and hence these patients require patient-specific approaches. There are major advantages in using this new technology for medical applications, however, in order to get this technology widely accepted in medical device industry, there is a need for gaining more acceptance from the medical device regulatory offices. This is a challenge that is moving onward and will help the technology find its way at the end as an accepted manufacturing method for medical device industry in an international scale. The discussion will conclude with some examples describing the future directions of 3D Medical Printing.

Keywords: CT/MRI, image processing, 3D printing, medical devices, patient specific implants

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Authors: D. Kliaugaitė, J. K, Staniškis

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In this study tree types of multilayer gas barrier plastic packaging films were compared using life cycle assessment as a tool for resource efficient and environmentally low-impact materials selection. The first type of multilayer packaging film (PET-AlOx/LDPE) consists of polyethylene terephthalate with barrier layer AlOx (PET-AlOx) and low density polyethylene (LDPE). The second type of polymer film (PET/PE-EVOH-PE) is made of polyethylene terephthalate (PET) and co-extrusion film PE-EVOH-PE as barrier layer. And the third one type of multilayer packaging film (PET-PVOH/LDPE) is formed from polyethylene terephthalate with barrier layer PVOH (PET-PVOH) and low density polyethylene (LDPE). All of analyzed packaging has significant impact to resource depletion, because of raw materials extraction and energy use and production of different kind of plastics. Nevertheless the impact generated during life cycle of functional unit of II type of packaging (PET/PE-EVOH-PE) was about 25% lower than impact generated by I type (PET-AlOx/LDPE) and III type (PET-PVOH/LDPE) of packaging. Result revealed that the contribution of different gas barrier type to the overall environmental problem of packaging is not significant. The impact are mostly generated by using energy and materials during raw material extraction and production of different plastic materials as plastic polymers material as PE, LDPE and PET, but not gas barrier materials as AlOx, PVOH and EVOH. The LCA results could be useful in different decision-making processes, for selecting resource efficient and environmentally low-impact materials.

Keywords: life cycle assessment, polymer packaging, resource efficiency, materials extraction, polyethylene terephthalate

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Authors: Noemia Gomes de Mattos de Mesquita, José Eduardo Ferreira de Oliveira, Arimatea Quaresma Ferraz

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Stops to exchange cutting tool, to set up again the tool in a turning operation with CNC or to measure the workpiece dimensions have a direct influence on production. The premature removal of the cutting tool results in high cost of machining since the parcel relating to the cost of the cutting tool increases. On the other hand, the late exchange of cutting tool also increases the cost of production because getting parts out of the preset tolerances may require rework for its use when it does not cause bigger problems such as breaking of cutting tools or the loss of the part. Therefore, the right time to exchange the tool should be well defined when wanted to minimize production costs. When the flank wear is the limiting tool life, the time predetermination that a cutting tool must be used for the machining occurs within the limits of tolerance can be done without difficulty. This paper aims to show how the life of the cutting tool can be calculated taking into account the cutting parameters (cutting speed, feed and depth of cut), workpiece material, power of the machine, the dimensional tolerance of the part, the finishing surface, the geometry of the cutting tool and operating conditions of the machine tool, once known the parameters of Taylor algebraic structure. These parameters were raised for the ABNT 1038 steel machined with cutting tools of hard metal.

Keywords: machining, productions, cutting condition, design, manufacturing, measurement

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Authors: Zainab Elazab, Azhar Aziz

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Background: Spontaneous Splenic artery pseudoaneurysm rupture is a rare condition which is potentially life threatening, if not detected and managed early. We report a case of abdominal pain with intraperitoneal free fluid, which turned out to be spontaneous rupture of a splenic artery pseudoaneurysm, and was treated with arterial embolization. Case presentation: A 28-year old, previously healthy male presented to the ED with a history of sudden onset upper abdominal pain and fainting attack. The patient denied any history of trauma or prior similar attacks. On examination, the patient had tachycardia and a low-normal BP (HR 110, BP 106/66) but his other vital signs were normal (Temp. 37.2, RR 18 and SpO2 100%). His abdomen was initially soft with mild tenderness in the upper region. Blood tests showed leukocytosis of 12.3 X109/L, Hb of 12.6 g/dl and lactic acid of 5.9 mmol/L. Ultrasound showed trace of free fluid in the perihepatic and perisplenic areas, and a splenic hypoechoic lesion. The patient remained stable; however, his abdomen became increasingly tender with guarding. We made a provisional diagnosis of a perforated viscus and the patient was started on IV fluids and IV antibiotics. An erect abdominal x-ray did not show any free air under the diaphragm so a CT abdomen was requested. Meanwhile, bedside ultrasound was repeated which showed increased amount of free fluid, suggesting intra-abdominal bleeding as the most probable etiology for the condition. His CT abdomen revealed a splenic injury with multiple lacerations, a focal intrasplenic enhancing area on venous phase scan (suggesting a pseudoaneurysm with associated splenic intraparenchymal, sub capsular and perisplenic hematomas). Free fluid in the subhepatic and intraperitoneal regions along the small bowel was also detected. Angiogram was done which confirmed a diagnosis of pseudoaneurysm of intrasplenic arterial branch, and angio-embolization was done to control the bleeding. The patient was later discharged in good condition with a surgery follow-up. Conclusion: Splenic artery pseudoaneurysm rupture is a rare cause of abdominal pain which should be considered in any case of abdominal pain with intraperitoneal bleeding. Early management is crucial as it carries a high mortality. Bedside ultrasound is a useful tool to help for early diagnosis of such cases.

Keywords: abdominal pain, pseudo aneurysm, rupture, splenic artery

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Authors: Dinesh Kumar Srivastava

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After liberalization of the economy, technical education has seen rapid growth in India. A large number of institutions are offering various engineering and management programmes. Every year, a number of students complete B. Tech/M. Tech and MBA programmes of different institutes, universities in India and search for jobs in the industry. A large number of companies visit educational institutes for campus placements. These companies are interested in hiring competent managers. Most students show preference for jobs from reputed companies and jobs having high compensation. In this context, this study was conducted to understand career preference of postgraduate students and junior executives. Personality characteristics influence work life as well as personal life. In the last two decades, five factor model of personality has been found to be a valid predictor of job performance and job satisfaction. This approach has received support from studies conducted in different countries. It includes neuroticism, extraversion, and openness to experience, agreeableness, and conscientiousness. Similarly three social needs, namely, achievement, affiliation and power influence motivation and performance in certain job functions. Both approaches have been considered in the study. The objective of the study was first, to analyse the relationship between personality characteristics and career preference of students and executives. Secondly, the study analysed the relationship between personality characteristics and skills of students. Three managerial skills namely, conceptual, human and technical have been considered in the study. The sample size of the study was 266 including postgraduate students and junior executives. Respondents have completed BE/B. Tech/MBA programme. Three dimensions of career preference namely, identity, variety and security and three managerial skills were considered as dependent variables. The results indicated that neuroticism was not related to any dimension of career preference. Extraversion was not related to identity, variety and security. It was positively related to three skills. Openness to experience was positively related to skills. Conscientiousness was positively related to variety. It was positively related to three skills. Similarly, the relationship between social needs and career preference was examined using correlation. The results indicated that need for achievement was positively related to variety, identity and security. Need for achievement was positively related to managerial skills Need for affiliation was positively related to three dimensions of career preference as well as managerial skills Need for power was positively related to three dimensions of career preference and managerial skills Social needs appear to be stronger predictor of career preference and managerial skills than big five traits. Findings have implications for selection process in industry.

Keywords: big five traits, career preference, personality, social needs

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Authors: Ju Yeon Lee, Seol Ah Oh, Hong il Kim, Hae Yong Do, Sung Won Choi

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The purpose of this study was to develop a Well-being and Moments Scale (WAMS) for evaluating the efficacy of ‘vacationing’ as a form of mental health recuperation. ‘Vacationing’ is defined as a going outside one’s usual environment to seek refreshment and relief from one’s daily life. To develop WAMS, we followed recommended procedures for scale development, including reviewing related studies, conducting focus group interviews to elucidate the need for this assessment area, and modifying items based on expert opinion. Through this process, we developed the WAMS. The psychometric properties of the WAMS were then tested in two separate samples. Exploratory factor analysis (EFA) was conducted using 1.41 participants (mean age = 30.45 years; range: 20-50 years) to identify the underlying 3-factor structure of 'Positive Emotions', 'Life Satisfaction' and 'Self-Confidence.' The 26 items retained based on the EFA procedures were associated with excellent reliability (i.e., α = 0.93). Confirmatory factor analysis was then conducted using 200 different participants (mean age = 29.51 years; range: 20-50 years) and revealed good model fit for our hypothesized 3-factor model. Convergent validity tests also revealed correlations with other scales in the expected direction and range. Study limitations as well as the importance and utility of WMAS are also discussed.

Keywords: vacationing, positive affect, life satisfaction, self-confidence, WAMS

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Authors: S. Saeed, T. Butt, M. Rehan, S. Khaliq

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Objective: To determine the frequency of pre-analytical errors in samples taken from patients for various lab tests at Fauji Foundation Hospital, Rawalpindi. Material and Methods: All the lab specimens for diagnostic purposes received at the lab from Fauji Foundation hospital, Rawalpindi indoor and outdoor patients were included. Total number of samples received in the lab is recorded in the computerized program made for the hospital. All the errors observed for pre-analytical process including patient identification, sampling techniques, test collection procedures, specimen transport/processing and storage were recorded in the log book kept for the purpose. Results: A total of 476616 specimens were received in the lab during the period of study including 237931 and 238685 from outdoor and indoor patients respectively. Forty-one percent of the samples (n=197976) revealed pre-analytical discrepancies. The discrepancies included Hemolyzed samples (34.8%), Clotted blood (27.8%), Incorrect samples (17.4%), Unlabeled samples (8.9%), Insufficient specimens (3.9%), Request forms without authorized signature (2.9%), Empty containers (3.9%) and tube breakage during centrifugation (0.8%). Most of these pre-analytical discrepancies were observed in samples received from the wards revealing that inappropriate sample collection by the medical staff of the ward, as most of the outdoor samples are collected by the lab staff who are properly trained for sample collection. Conclusion: It is mandatory to educate phlebotomists and paramedical staff particularly performing duties in the wards regarding timing and techniques of sampling/appropriate container to use/early delivery of the samples to the lab to reduce pre-analytical errors.

Keywords: pre analytical lab errors, tertiary care hospital, hemolyzed, paramedical staff

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Authors: Kailas Bhandarkar, Talib Dar, Laura Karia, Manasvi Upadhyaya

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Introduction: Frenotomy for tongue tie is commonly performed in breastfed infants who experience difficulty in latching after failed conservative management for tongue tie. However, there is no consensus for the routine use of massage following frenotomy. Our aim was to assess the efficacy of massage in preventing recurrence following frenotomy. Methods: The tongue tie service in our tertiary referral hospital consists of 5 consultants and a breastfeeding (BF) midwife. 3 consultants routinely advice massage post procedure. Babies are assessed by the midwife after the procedure and a follow-up consultation after a week. After due ethical approval, data were collected by two staff members who were independent of TT service on a standardized questionnaire to avoid bias. Fischer exact test was employed (p < 0.05 considered significant). Results: Six hundred and thirty-two babies attended the clinic from January 2018 to December 2018. Thirty-three of these were excluded as the procedure was not needed. Parents were contacted at a median of six months post-procedure (range 2-10 months). 282/599 were advised massage. 92/282 could be contacted. 40/ 92 adhered to massage regimen. None of these had a recurrence. 52/92 (54%), although advised, did not perform massage. Reasons cited for lack of adherence to massage included difficulty in performing massaging and conflicting advice given by other health care professionals involved in patient care like paediatricians and group practice and lack of information on the internet). Overall, 4/599 (0.66%) had recurrences, and this difference was not statistically significant. Conclusion: In our experience, the rate of recurrence after frenotomy is low enough for us to conclude that there is no significant benefit of massage after frenotomy for tongue tie. We could also conclude that among parents who were advised massage more than half failed to adhere to the advice.

Keywords: tongue tie, frenotomy, massage, recurrence

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Authors: Judith Hanke

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Due to the increase of students with reading difficulties, digital reading support with diagnostics was developed to foster the individual student's reading comprehension. The digital reading support focused on the reading comprehension of elementary school students. The digital reading packages consist of literary texts with aligned reading exercises. The number of students with German as a second language is growing in Germany. Students with multilingualism, language 1, and language 2 learn German together in school. The research's focus is on determining whether and to what extent multilingualism, language 1, and language 2 affect reading comprehension. For the methodology, an ABA design was selected for the intervention study to examine the reading support. The study was expedited from April 2023 until July 2023 and collected quantitative data of individuals, groups, and classes. It comprised a survey group (N = 58) and a control group (N = 53). The quantitative data was collected from 3 classes of 3 teachers and 47 students for all three test times. To show differences between the groups, a standardized reading comprehension test was used for the three test times, pretest, posttest, and follow-up. The standardized test consists of three subtests regarding word comprehension, sentence comprehension, and text comprehension. The main findings include that students who spoke German as their first language had the best test scores. Interestingly, students with a different language had better testing scores than students with German as the first language and (an) other language/s. Also, the students with another language outperformed the native language speakers in one of the subtests of the post-testing. The variables of spoken language at home and German as a second language were also examined and correlated with the test results. One significant correlation was found between spoken language at home and the text comprehension test of the pretesting. Additionally, the variable German as a second language had multiple significant correlations in the pretest, posttest and follow-up. The study's significance is to understand the influence of several languages, language 1, and language 2, on reading comprehension.

Keywords: multilingualism, language 1, language 2, reading comprehension, second language

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