Search results for: heart issue

Authors: Konstantinos Liagkouras, Konstantinos Metaxiotis

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In this paper we present a classification of the various technologies applied for the solution of the portfolio selection problem according to the discipline and the methodological framework followed. We provide a concise presentation of the emerged categories and we are trying to identify which methods considered obsolete and which lie at the heart of the debate. On top of that, we provide a comparative study of the different technologies applied for efficient portfolio construction and we suggest potential paths for future work that lie at the intersection of the presented techniques.

Keywords: portfolio selection, optimization techniques, financial models, stochastic, heuristics

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Authors: J. Yan, B. Pieper, B. Bucsky, B. Nasseri, S. Klotz, H. H. Sievers, S. Mohamed

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Cryoablation is evermore applied for interventional treatment of paroxysmal (PAAF) or persistent atrial fibrillation (PEAF). In the cardiac surgery, this procedure is often combined with coronary arterial bypass graft (CABG) and valve operations. Three different methods are feasible in this sense in respect to practicing extents and mechanisms such as lone left atrial cryoablation, Cox-Maze IV and III in our heart center. 415 patients (68 ± 0.8ys, male 68.2%) with predisposed atrial fibrillation who initially required either coronary or valve operations were enrolled and divided into 3 matched groups according to deployed procedures: CryoLA-group (cryoablation of lone left atrium, n=94); Cox-Maze-IV-group (n=93) and Cox-Maze-III-group (n=8). All patients additionally received closure of the left atrial appendage (LAA) and regularly underwent three-year ambulant follow-up assessments (3, 6, 9, 12, 18, 24, 30 and 36 months). Burdens of atrial fibrillation were assessed directly by means of cardiac monitor (Reveal XT, Medtronic) or of 3-day Holter electrocardiogram. Herewith, attacks frequencies of AF and their circadian patterns were systemically analyzed. Furthermore, anticoagulants and regular rate-/rhythm-controlling medications were evaluated and listed in terms of anti-rate and anti-rhythm regimens. Concerning PAAF treatment, Cox Maze IV procedure provided therapeutically acceptable effect as lone left atrium (LA) cryoablation did (5.25 ± 5.25% vs. 10.39 ± 9.96% AF-burden, p > 0.05). Interestingly, Cox Maze III method presented a better short-term effect in the PEAF therapy in comparison to lone cryoablation of LA and Cox Maze IV (0.25 ± 0.23% vs. 15.31 ± 5.99% and 9.10 ± 3.73% AF-burden within the first year, p < 0.05). But this therapeutic advantage went lost during ongoing follow-ups (26.65 ± 24.50% vs. 8.33 ± 8.06% and 15.73 ± 5.88% in 3rd follow-up year). In this way, lone LA-cryoablation established its antiarrhythmic efficacy and 69.5% patients were released from the Vit-K-antagonists, while Cox Maze IV liberated 67.2% patients from continuous anticoagulant medication. The AF-recurrences mostly performed such attacks property as less than 60min duration for all 3 procedures (p > 0.05). In the sense of the circadian distribution of the recurrence attacks, weighted by ongoing follow-ups, lone LA cryoablation achieved and stabilized the antiarrhythmic effects over time, which was especially observed in the treatment of PEAF, while Cox Maze IV and III had their antiarrhythmic effects weakened progressively. This phenomenon was likewise evaluable in the therapy of circadian rhythm of reverting AF-attacks. Furthermore, the strategy of rate control was much more often applied to support and maintain therapeutic successes obtained than the one of rhythm control. Derived from experiences in our heart center, lone LA cryoablation presented equivalent effects in the treatment of AF in comparison to Cox Maze IV and III procedures. These therapeutic successes were especially investigable in the patients suffering from persistent AF (PEAF). Additional supportive strategies such as rate control regime should be initialized and implemented to improve the therapeutic effects of the cryoablations according to appropriate criteria.

Keywords: AF-burden, atrial fibrillation, cardiac monitor, COX MAZE, cryoablation, Holter, LAA

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Authors: Husnul Isa Harahap

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On December 2, 2016 occurred mass movements in Indonesia, led by the National Movement of Fatwa Guard, Indonesian Ulema Council (GNPF MUI). This movement is named 212 in accordance with the date, and also called The Third Islamic Defend Action, a continued movement of Islamic defend earlier (November 4, 2016 and October 14, 2016). All three movements have raised the issue of the demand that Basuki Tjahaja Purnama (Jakarta governor) also known as Ahok put on trial for allegedly insulting the Quran. The interesting view of this movement is that: first, the great social movement could emerge from a small but sensitive issues. Second, although this movement followed by radical Islamic groups, that movement known as the largest and most peaceful Islamic Movement in Indonesia. Third, the movement succeeded in answer the doubts of many parties that the social movements with large masses can not maintain security, order, and even the cleanliness of the site action. What causes all this happen? First, the emphasis on the use of basic religious elements that Islam is love for peace. Second, the role of leadership that is trusted and based on religious relationship. Third, this movement is well organized and trying reflect Islamic values.

Keywords: Islamic values, social movement, peaceful group, sensitive issue

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Authors: A. Aldawsari

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The complex issue of women working in a mixed-gender work environment has its roots in social and cultural factors. This research was done to identify and explore the social and cultural challenges Saudi women face in a mixed-gender work environment in Saudi Arabia. Over the years, Saudi women in mixed-gender work environments in Saudi Arabia have been of interest in various research areas, especially within the context of a hospital work environment. This research, which involves a female researcher interacting one-on-one with Saudi women, will address this issue as well as the effect of the 2030 Vision in Saudi Arabia, and it will aim to include several new fields of work environments for women in Saudi Arabia. The aim of this research is to examine the perceptions of Saudi women who work in a mixed gender environment regarding the general empowerment of women in these settings. The objective of this research is to explore the cultural and social challenges that influence Saudi women's rights to work in a mixed-gender environment in Saudi Arabia. The significance of this research lies in the fact that there is an urgency to resolve issue of female employment in Saudi Arabia, where Saudi women still suffer from inequality in employment opportunity. Although the Saudi government is seeking to empower women by integrating them into a mixed-gender work environment, which is a key goal and prominent social change advocated for in the 2030 Vision, this same goal is one of the main challenges in the face of achieving female empowerment. The methodology section focuses on appropriate methods that can be used to study the effect of social and cultural challenges on the employment of women. It then determines the conditions and limitations of the research by applying a qualitative research approach to the investigation and analysing the data collected from the interviews. A statistical analysis tool, such as NVivo, will be used for the qualitative analysis of the interviews. The study found that the factor most responsible for creating social and cultural challenges is family—whether close family or distant family—more so than tribe or community.

Keywords: women, work, mixed-gender, environment

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Authors: Aishwarya Pothula

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Euthanasia in India is a politically dormant policy issue in the sense that discussions around it are sporadic in nature (usually with developments in specific cases) and it stays as a dominant issue in the public domain for a fleeting period. In other words, it is a non-political issue that has been unable to successfully get on the policy agenda. This paper studies how the Supreme Court of India (SC) plays a role in euthanasia’s policy making. In 2011, the SC independently put a law in place that legalized passive euthanasia through its judgement in the Aruna Shanbaug v. Union of India case. According to this, it is no longer illegal to withhold/withdraw a patient’s medical treatment in certain cases. This judgement, therefore, is the empirical focus of this paper. The paper essentially employs two techniques of discourse analysis to study the SC’s system of argumentation. The two methods, Text Analysis using Gasper’s Analysis Table and Frame Analysis – are complemented by two discourse techniques called metaphor analysis and lexical analysis. The framework within which the analysis is conducted lies in 1) the judicial process of India, i.e. the SC procedures and the Constitutional rules and provisions, and 2) John W. Kingdon’s theory of policy windows and policy entrepreneurs. The results of this paper are three-fold: first, the SC dismiss the petitioner’s request for passive euthanasia on inadequate and weak grounds, thereby setting no precedent for the historic law they put in place. In other words, they leave the decision open for the Parliament to act upon. Hence the judgement, as opposed to arguments by many, is by no means an instance of judicial activism/overreach. Second, they define euthanasia in a way that resonates with existing broader societal themes. They combine this with a remarkable use of authoritative and protective tones/stances to settle at an intermediate position that balances the possible opposition to their role in the process and what they (perhaps) perceive to be an optimal solution. Third, they soften up the policy community (including the public) to the idea of passive euthanasia leading it towards a Parliamentarian legislation. They achieve this by shaping prevalent principles, provisions and worldviews through an astute use of the legal instruments at their disposal. This paper refers to this unconventional role of the SC as ‘judicial entrepreneurship’ which is also the first scholarly contribution towards research on euthanasia as a policy issue in India.

Keywords: argumentation analysis, Aruna Ramachandra Shanbaug, discourse analysis, euthanasia, judicial entrepreneurship, policy-making process, supreme court of India

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Authors: Magdaléna Náplavová, Tomáš Ludík, Petr Hrůza, František Božek

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The use of IT equipment has become a part of every day. However, each device that is part of cyberspace should be secured against unauthorized use. It is very important to know the basics of these security devices, but also the basics of safe conduct their owners. This information should be part of every curriculum computer science education in primary and secondary schools. Therefore, the work focuses on the education of pupils in primary and secondary schools on the Internet. Analysis of the current state describes approaches to the education of pupils in security issues on the Internet. The paper presents a questionnaire-based survey which was carried out in the Czech Republic, whose task was to ascertain the level of opinion pupils in primary and secondary schools on the issue of communication in social networks. The research showed that awareness of socio-pathological phenomena on the Internet environment is very low. Based on the results it was proposed appropriate ways of teaching to this issue and its inclusion a proposal of curriculum for primary and secondary schools.

Keywords: information security, cyber space, general awareness, questionnaire, socio-pathological phenomena, educational system

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Authors: Prem, Norhaya, Vwrene C., Mohammad Harris A., Amarjit, Fazir M.

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Upper limb surgery is a common orthopedic procedure. After surgery, it is necessary to raise the patient's arm to reduce limb swelling and promote recovery. After an injury or surgery, swelling (edema) in the limbs is common. This swelling can be painful, cause stiffness, and affect movement and ability to do daily activities. One of the easiest ways to manage swelling is to elevate the swollen limb. The goal is to elevate the swollen limb slightly above the level of the heart. This helps the extra fluid move back towards the heart for circulation to the rest of the body. Conventional arm sling or pillows are usually placed under the arm to raise it, but in this way the arm cannot be fixed well and easily slide down, without ideal raising effect. Conventional arm sling need experience to tie the sling and this delay in the application process. To reduce the waiting time and cost, modified Norhaya upper limb elevation sling was designed and made readily available. The sling is made from calico fabric, readily available in the ward. Measurements of patients’ arm lengths are obtained, and fabric sizes are cut into the average arm lengths, as well as 1 size above and below. The cut calico fabric is then sewn together with thick sewing threads. Its application is easy and junior most staff or doctor will be able to apply it on patient. The time taken to set up the sling is also reduced. Feedback gathered from ground staff regarding ease of setting up the sling was tremendous and patient also feel comfort in the modified Norhaya sling. The device can freely adjust the raising height of the affected limb and effectively fix the affected limb to reduce its swelling, thus promoting recovery. This device is worthy to be clinically popularized and applied. The Modified Norhaya upper limb elevation sling is the quickest to set up and the delay in elevating the patient’s hand is significantly reduced. Moreover, it is reproducible and there is also significant cost savings.

Keywords: elevate, effective, sling, timely

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Authors: Gulfam Hasan, Ijaz Ashraf, Saleem Ashraf, Muhammad Rafay Muzammil, Salman Asghar, Shafiq-Ur-Rehman Zia

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The word “climate change” has become the most popular term when anyone observes any uncertain climate variation in their respective region. Asian countries are more prone to the impact of this phenomenon, and Pakistan is the leading affected country. Last few years, governments all over the world have been trying to cater to this issue for the best entrust of their population, especially agriculture. Now the farmers in Pakistan are fully aware of the term “climate change” and are more concerned about its solutions. On the other hand, developed countries like the USA are setting a benchmark for developing countries in every sphere of life. Based on cultural and other variations, the research was carried out to identify the behavior of farmers regarding the same issue. Cross-sectional survey research was designed for an in-depth study of relevant research questions. Face-to-face interviews were conducted in Pakistan, while virtual and face-to-face interviews were conducted in the Indiana State of the USA. The results of the present study and the responses of farmers were very interesting. The common climate change mitigation strategies suggested by farmers of both countries were less use of motor vehicles (replacement with bicycles in the circle of 10 Km), less dependency on chemical fertilizers (increased use of Manure, Bio-fertilizer, Compost), and plantation of the tree. The difference of opinion was in less government interest, lack of farmers’ education, political instability (views of Pakistani farmers), awareness of local communities, self-satisfaction, and economic disparities (views of USA farmers). Based on the given evidence, it was recommended that there is a dire need to address the climate change issue all over the world without discrimination of race, color, region, or religion. Because it will affect not only agriculture but also the real effect will be on HUMANITY.

Keywords: climate change, mitigation strategies, forests, biodiversity

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Authors: Sabita Mahapatra

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‘Going green’ has been an emerging issue worldwide driving companies to continuously enhance their green capabilities and implement innovative green practices to protect the environment and improve business performance. Green has become a contemporary business environmental issue. The resource advantage theory is adopted in the present study to observe the impact of marketing orientation and green innovation practices on environmental and firm’s performance. The small and medium firms compared to large firms have different approach towards market orientation as a strategic tool. The present study proposes a conceptual framework regarding the impact of market orientation on environmental and firm’s performance through green innovation practices in the context of small and medium scale industries (SMEs). The propositions developed in the present paper would provide scope for future research study to validate the conceptual framework in the emerging economy like India.

Keywords: market orientation, green innovation practices, environment performance, corporate performance, emerging market

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Authors: Nkechi V. Osuji

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The use of blockchain to address the issue of climate change is increasingly a discourse among countries, industries, and stakeholders. For a long time, the European Union (EU) has been combating the issue of climate action in industries through sustainability programs. One of such programs is the EU monitoring reporting and verification (MRV) program of the EU ETS. However, the system has some key challenges and areas for improvement, which makes it inefficient. The main objective of the research is to look at how blockchain can be used to improve the inefficiency of the EU ETS program for the Danish energy industry with a focus on its monitoring and reporting framework. Applying empirical data from 13 semi-structured expert interviews, three case studies, and literature reviews, three outcomes are presented in the study. The first is on the current conditions and challenges of monitoring and reporting CO₂ emission trading. The second is putting into consideration if blockchain is the right fit to solve these challenges and how. The third stage looks at the factors that might affect the implementation of such a system and provides recommendations to mitigate these challenges. The first stage of the findings reveals that the monitoring and reporting of CO₂ emissions is a mandatory requirement by law for all energy operators under the EU ETS program. However, most energy operators are non-compliant with the program in reality, which creates a gap and causes challenges in the monitoring and reporting of CO₂ emission trading. Other challenges the study found out are the lack of transparency, lack of standardization in CO₂ accounting, and the issue of double-counting in the current system. The second stage of the research was guided by three case studies and requirement engineering (RE) to explore these identified challenges and if blockchain is the right fit to address them. This stage of the research addressed the main research question: how can blockchain be used for monitoring and reporting CO₂ emission trading in the energy industry. Through analysis of the study data, the researcher developed a conceptual private permissioned Hyperledger blockchain and elucidated on how it can address the identified challenges. Particularly, the smart contract of blockchain was highlighted as a key feature. This is because of its ability to automate, be immutable, and digitally enforce negotiations without a middleman. These characteristics are unique in solving the issue of compliance, transparency, standardization, and double counting identified. The third stage of the research presents technological constraints and a high level of stakeholder collaboration as major factors that might affect the implementation of the proposed system. The proposed conceptual model requires high-level integration with other technologies such as the Internet of Things (IoT) and machine learning. Therefore, the study encourages future research in these areas. This is because blockchain is continually evolving its technology capabilities. As such, it remains a topic of interest in research and development for addressing climate change. Such a study is a good contribution to creating sustainable practices to solve the global climate issue.

Keywords: blockchain, carbon emission trading, European Union emission trading system, monitoring and reporting

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Authors: T. J. Stepien, L. T. Stepien

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This abstract concerns an extremely fundamental issue. Namely, the fundamental problem of science is the issue of consistency. In this abstract, we present the theorem saying that the classical calculus of quantifiers is inconsistent in the traditional sense. At the beginning, we introduce a notation, and later we remind the definition of the consistency in the traditional sense. S1 is the set of all well-formed formulas in the calculus of quantifiers. RS1 denotes the set of all rules over the set S1. Cn(R, X) is the set of all formulas standardly provable from X by rules R, where R is a subset of RS1, and X is a subset of S1. The couple < R,X > is called a system, whenever R is a subset of RS1, and X is a subset of S1. Definition: The system < R,X > is consistent in the traditional sense if there does not exist any formula from the set S1, such that this formula and its negation are provable from X, by using rules from R. Finally, < R0+, L2 > denotes the classical calculus of quantifiers, where R0+ consists of Modus Ponens and the generalization rule. L2 is the set of all formulas valid in the classical calculus of quantifiers. The Main Result: The system < R0+, L2 > is inconsistent in the traditional sense.

Keywords: classical calculus of quantifiers, classical predicate calculus, generalization rule, consistency in the traditional sense, Modus Ponens

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Authors: Maria Luisa Barcena De Arellano, Sofya Pozdniakova, Pavelas Karkacas, Anja Kuhl, Istvan Baczko, Yury Ladilov, Vera Regitz-Zagrosek

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Introduction: Aging is associated with deterioration of the physiological function, leading to systemic inflammation and mitochondrial dysfunction that promote the development of cardiovascular diseases. Sex differences in aging-related cardiovascular diseases have been postulated. However, their precise mechanisms remain unclear. In the current study, we aimed to investigate the sex difference in the age-related alteration in Sirt1-AMPK signaling and its relation to the mitochondrial biogenesis and inflammation. Methods: Male and female human non-disease lateral left ventricular wall tissue (young (17–40 years; n= 7 male and 7 female) and old (50–68 years; n= 9 male and 8 female)) were used. qRT-PCR, western blot and immunohistochemistry assays were performed for expression analyses of Sirt1, AMPK, pAMPK, ac-Ku70, TFAM, PGC-1α, Sirt3, SOD2 and catalase. CD68 was used as a marker for macrophages and the ratio of IL-12:IL10 (pro-inflammatory phenotype (high IL-12/low IL-10) and anti-inflammatory phenotype (low IL-12/high IL-10) was used to examine the inflammatory stage in the heart. Results: Sirt1 expression was significantly higher in young females compared to young males, whereas in aged hearts Sirt1 expression was significantly downregulated in females, but not in males. In line with the Sirt1 downregulation in aged females, acetylation of nuclear Ku70, a direct target of Sirt1, in aged female hearts was significantly elevated. The activity of AMPK was significantly decreased in aged individuals, however no sex differences in the AMPK expression or activity were found in young or old individuals. The expression of mitochondrial proteins TOM40, SOD2 and Sirt3 was significantly higher in young females compared to young males, while in aged female hearts SOD2 and TOM40 were downregulated. In addition, the expression of catalase, a key cytosolic and mitochondrial anti-oxidative enzyme was significantly higher in young females and this female sex benefit was lost in aged hearts. In addition, the number of cardiac macrophages was significantly increased in old female, but not in male hearts. Consistently, the pro-inflammatory shift in old females was further confirmed by differences in the IL12/IL10 ratio in young female cardiac tissue in a favour of the anti-inflammatory mediator IL-10 (ratio 1:4) compared to young males (ratio 1:1). The anti-inflammatory environment in the heart was lost in aged females (ratio 1:1). Conclusion: Aging leads to the significant downregulation of Sirt1 expression and elevated acetylation of Ku70 in female, but not in male hearts. Furthermore, a beneficial upregulation of mitochondrial and anti-oxidative proteins in young females is lost with aging. Moreover, the malfunctions in the expression of Sirt1 and mitochondrial proteins in aged female hearts is accompanied by a significant pro-inflammatory shift. The study provides a molecular basis for the increased incidence of cardiovascular diseases in old women.

Keywords: inflammation, mitochondrial dysfunction, aging, Sirt1-AMPK axis

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Authors: Fatima Kiran

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This study investigates the HIV/AIDS coverage in the selected newspapers. The premises of the study depend upon the fact that informing public about any social issue that effects people’s life is among one of the fundamental functions of media, such as HIV/AIDS is one of prime importance. In this study two most prime newspapers of Pakistan Daily Jang and Daily Dawn were analyzed. This paper adopted two approaches for investigation one is content analysis and another is discourse analysis. The content analysis was used to determine the frequency of HIV/AIDS content coverage. Discourse analysis was used to determine consciousness of these newspapers on covering HIV/AIDS stories with correct language and terminologies according to the given media guideline of UNICEF. Total 368 editions from 1st July 2017 to 31st December 2017 were sampled for the study. The result of the study indicates that newspapers have severely underestimated the severity of HIV/AIDS. The coverage given by newspapers is dissatisfactory. Selected newspapers used inappropriate terminologies and language in the stories which shows negligence of newspapers regarding HIV/AIDS issue.

Keywords: Pakistani newspapers, HIV/AIDS, coverage, public awareness, content analysis, discourse analysis, press consciousness

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Authors: Ghulam Haider Haidaree, Nsenda Lukumwena

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Most developing nations face energy production and supply problems. This is also the case of Afghanistan whose generating capacity does not meet its energy demand. This is due in part to high security and risk caused by war which deters foreign investments and insufficient internal revenue. To address the issue above, this paper would like to suggest an alternative and affordable way to deal with the energy problem. That is by converting Solid Waste to energy. As a result, this approach tackles the municipal solid waste issue (potential cause of several diseases), contributes to the improvement of the quality of life, local economy, and so on. While addressing the solid waste problem in general, this paper samples specifically one municipality which is District-12, one of the 22 districts of Kabul city. Using geographic information system (GIS) technology, District-12 is divided into nine different zones whose municipal solid waste is respectively collected, processed, and converted into electricity and distributed to the closest area. It is important to mention that GIS has been used to estimate the amount of electricity to be distributed and to optimally position the production plant.

Keywords: energy problem, estimation of electricity, GIS zones, solid waste management system

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Authors: Zhaoqi He

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Research Context: Endurance performance in hot environments is influenced by the interplay of hydration status and physiological responses. This study aims to investigate how dehydration, up to 2.11% body weight loss, affects the 3 km running performance of trained male athletes under conditions mimicking high temperatures. Methodology: In a randomized crossover design, five male athletes participated in two trials – euhydrated (EU) and dehydrated (HYPO). Both trials included a 70-minute preload run at 55-60% VO2max in 32°C and 50% humidity, followed by a 3-kilometer time trial. Fluid intake was restricted in HYPO to induce a 2.11% body weight loss. Physiological metrics, including heart rate, core temperature, and oxygen uptake, were measured, along with perceptual metrics like perceived exertion and thirst sensation. Findings: The 3-kilometer run completion times showed no significant differences between EU and HYPO trials (p=0.944). Physiological indicators, including heart rate, core temperature, and oxygen uptake, did not significantly vary (p>0.05). Thirst sensation was markedly higher in HYPO (p=0.013), confirming successful induction of dehydration. Other perceptual metrics and gastrointestinal comfort remained consistent. Conclusion: Contrary to the hypothesis, the study reveals that dehydration, inducing up to 2.11% body weight loss, does not significantly impair 3 km running performance in trained male athletes under hot conditions. Thirst sensation was notably higher in the dehydrated state, emphasizing the importance of considering perceptual factors in hydration strategies. The findings suggest that trained runners can maintain performance despite moderate dehydration, highlighting the need for nuanced hydration guidelines in hot-weather running.

Keywords: hypohydration, euhydration, hot environment, 3km running time trial, endurance performance, trained athletes, perceptual metrics, dehydration impact, physiological responses, hydration strategies

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Authors: Sabri Gabran Mohammed Elkrghli, Salah A. Mohamed Abdulgader

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Given the emergence and the spreading of the Covid-19 pandemic that swept the globe, it was necessary to address the issue of consumer rights in such unprecedented circumstances. Libyan consumers have been targeted in this study with the aim to measure their attitudes towards the extent to which their rights, as consumers of foodstuff, have been secured during the Covid-19 pandemic. The recommended sample size was randomly selected (384) local participants. Out of this number, only a validated number of (267) responses were deemed valid for the analysis phase. The instrument of this research was developed based on the extant published literature on consumer rights. The study concluded with a set of key results; the most important result is that consumer rights of foodstuffs were below the satisfactory level. Theoretical and practical implications have emerged from the study. The most important implication is that customers of foodstuffs need more protection in Libya. This issue should be given greater importance, especially in the light of contemporary environmental challenges such as the outbreak of Covid-19. Designing and conducting global and local awareness campaigns is another significant advice suggested by this study. Finally, the research concluded with limitations and put forward some future avenues.

Keywords: consumers rights, foodstuffs, COVID-19, Libya

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Authors: Yori Gidron, Laura Caton, Irit Ben-Aharon

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Background: Many patients and even certain clinicians attribute cancer development to psychosocial factors. Yet, empirical data supports more the prognostic role, rather than the etiological role, of psychosocial factors in cancer. Part of the inconsistency may result from not considering possible moderating factors in the etiological role of psychosocial factors. One important candidate moderating factor is the vagal nerve, whose activity is indexed by heart-rate variability (HRV). The vagal nerve may prevent cancer since it reduces inflammation on the one hand, and since it increases anti-tumor immunity on the other hand. This study examined the moderating role of the vagus in the relation between life threatening events (LTE) and cancer development. Method: We re-analyzed data from the Lifelines Dutch longitudinal cohort study of over 150,000 people. The present study included 82,751 adults, who initially were cancer-free. We extracted information on background factors (e.g., age, gender, fat consumption), whether they ever experienced LTE, HRV and cancer diagnosis as reported by patients in annual clinic visits. HRV was derived from brief ECGs. Results: Of the full sample, 1011 people developed cancer during a follow-up. In the full sample, LTE significantly predicted cancer development (R.R = 1.063 p < .01) and HRV significantly predicted a reduced risk of cancer development (R.R = .506 p <.001). Importantly, LTE significantly predicted cancer only when HRV was low (R.R = 1.056, 95% CI: 1.007 - 1.108, p < .05) but not when HRV was high (R.R = 1.014; 95% CI: 0.916 - 1.122, p > 0.05), independent of confounders. Conclusions: To the best of our knowledge, this is the first study showing in a large sample that LTE predict cancer development, and that this occurs only when vagal nerve activity (HRV) is relatively low. These results could result from lack of vagal modulation of inflammation and also from lack of vagal modulation of stress responses. Results are in line with the cancer-protective role of the vagus. HRV needs to be routinely monitored in the population and future intervention trials need to examine whether vagal nerve activation can prevent cancer in people with LTE and with other cancer risk factors.

Keywords: cancer development, life-events, moderation, vagal nerve

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Authors: A. Bortkiewcz, A. Dudarewicz, P. Małecki, M. Kłaczyński, T. Wszołek, Małgorzata Pawlaczyk-Łuszczyńska

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Low-frequency noise (LFN) has been recognized as a special environmental pollutant. It is usually considered a broadband noise with the dominant content of low frequencies from 10 Hz to 250 Hz. A growing body of data shows that LFN differs in nature from other environmental noises, which are at comparable levels but not dominated by low-frequency components. The primary and most frequent adverse effect of LFN exposure is annoyance. Moreover, some recent investigations showed that LFN at relatively low A-weighted sound pressure levels (40−45 dB) occurring in office-like areas could adversely affect the mental performance, especially of high-sensitive subjects. It is well documented that high-frequency noise disturbs various types of human functions; however, there is very little data on the impact of LFN on well-being and health, including the cardiovascular system. Heart rate variability (HRV) is a sensitive marker of autonomic regulation of the circulatory system. Walker and co-workers found that LFN has a significantly more negative impact on cardiovascular response than exposure to high-frequency noise and that changes in HRV parameters resulting from LFN exposure tend to persist over time. The negative reactions of the cardiovascular system in response to LFN generated by wind turbines (20-200 Hz) were confirmed by Chiu. The scientific aim of the study is to assess the relationship between the spectral-temporal characteristics of LFN and the activity of the autonomic nervous system, considering the subjective assessment of annoyance, sensitivity to this type of noise, and cognitive and general health status. The study will be conducted in 20 male students in a special, acoustically prepared, constantly supervised room. Each person will be tested 4 times (4 sessions), under conditions of non-exposure (sham) and exposure to noise of wind turbines recorded at a distance of 250 meters from the turbine with different frequencies and frequency ranges: acoustic band 20 Hz-20 kHz, infrasound band 5-20 Hz, acoustic band + infrasound band. The order of sessions of the experiment will be randomly selected. Each session will last 1 h. There will be a 2-3 days break between sessions to exclude the possibility of the earlier session influencing the results of the next one. Before the first exposure, a questionnaire will be conducted on noise sensitivity, general health status using the GHQ questionnaire, hearing organ status and sociodemographic data. Before each of the 4 exposures, subjects will complete a brief questionnaire on their mood and sleep quality the night before the test. After the test, the subjects will be asked about any discomfort and subjective symptoms during the exposure. Before the test begins, Holter ECG monitoring equipment will be installed. HRV will be analyzed from the ECG recordings, including time and frequency domain parameters. The tests will always be performed in the morning (9-12) to avoid the influence of diurnal rhythm on HRV results. Students will perform psychological tests 15 minutes before the end of the test (Vienna Test System).

Keywords: neurovegetative control, heart rate variability (HRV), cognitive processes, low frequency noise

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Authors: Tracy B. E. Omorogiuwa

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Human trafficking also known as modern-day slavery can be seen as an effort by some privileged and criminally minded persons to take advantage of vulnerable individuals for their economic gains. Some factors; poverty, unemployment, poor educational opportunities, ignorance and traditional attitudes are attributed as causes and psychological, sexual, moral and health problems as impacts of human trafficking. This study examines the phenomenon of human trafficking in Benin City, one of the cities in Nigeria, situated as a source of trafficked persons for exploitation in Europe and African countries. Even though the Nigerian government and Non-governmental organizations have made considerable efforts in the past to reduce the incidence of human trafficking, the result has been an adjustment in the personality of the trafficked persons rather than professional measures to combat the issue. Hence, the study adopts the focused group discussions as a method for data collection; to sort the opinions of community members towards the understanding of the phenomenon. In addition, this paper provides social work implications to address the issue of human trafficking in the Benin City, Nigeria.

Keywords: human trafficking, trafficking in persons, modern-day slavery, social work implication

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Authors: Lauren Dhugga, Meena Parameswaran, David Blundell, Abbas Khushnood

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Context: A multidisciplinary weekly safety briefing was implemented at the Paediatric Cardiothoracic Unit at the Freeman Hospital in Newcastle-upon-Tyne. It is a tertiary referral centre with a quarternary cardiac paediatric intensive care unit and provides complexed care including heart and lung transplants, mechanical support and advanced heart failure assessment. Aim: The aim of this briefing is to provide a structured platform of communication, in an effort to improve efficiency, safety, and patient care. Problem: The paediatric cardiothoracic unit is made up of a vast multidisciplinary team including doctors, intensivists, anaesthetists, surgeons, specialist nurses, echocardiogram technicians, physiotherapists, psychologists, dentists, and dietitians. It provides care for children with congenital and acquired cardiac disease and is one of only two units in the UK to offer paediatric heart transplant. The complexity of cases means that there can be many teams involved in providing care to each patient, and frequent movement of children between ward, high dependency, and intensive care areas. Currently, there is no structured forum for communicating important information across the department, for example, staffing shortages, prescribing errors and significant events. Strategy: An initial survey questioning the need for better communication found 90% of respondents agreed that they could think of an incident that had occurred due to ineffective communication, and 85% felt that incident could have been avoided had there been a better form of communication. Lastly, 80% of respondents felt that a weekly 60 second safety briefing would be beneficial to improve communication within our multidisciplinary team. Based on those promising results, a weekly 60 second safety briefing was implemented to be conducted on a Monday morning. The safety briefing covered four key areas (SAFE): staffing, awareness, fix and events. This was to highlight any staffing gaps, any incident reports to be learned from, any issues that required fixing and any events including teachings for the week ahead. The teams were encouraged to email suggestions or issues to be raised for the week or to approach in person with information to add. The safety briefing was implemented using change theory. Effect: The safety briefing has been trialled over 6 weeks and has received a good buy in from staff across specialties. The aim is to embed this safety briefing into a weekly meeting using the PDSA cycle. There will be a second survey in one month to assess the efficacy of the safety briefing and to continue to improve the delivery of information. The project will be presented at the next clinical governance briefing to attract wider feedback and input from across the trust. Lessons: The briefing displays promise as a tool to improve vigilance and communication in a busy multi-disciplinary unit. We have learned about how to implement quality improvement and about the culture of our hospital - how hierarchy influences change. We demonstrate how to implement change through a grassroots process, using a junior led briefing to improve the efficiency, safety, and communication in the workplace.

Keywords: briefing, communication, safety, team

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Authors: P. Thachitasing, N. Jansawang, W. Rakrai, T. Santiboon

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The aim of this study is to investigate of the comparing the instructional design models between the Think-Pair-Share and Conventional Learning (5E Inquiry Model) Processes to enhance students’ learning achievements and their problem solving skills on stoichiometry issue for concerning the 2-instructional method with a sample consisted of 80 students in 2 classes at the 11th grade level in Chaturaphak Phiman Ratchadaphisek School. Students’ different learning outcomes in chemistry classes with the cluster random sampling technique were used. Instructional Methods designed with the 40-experimenl student group by Think-Pair-Share process and the 40-controlling student group by the conventional learning (5E Inquiry Model) method. These learning different groups were obtained using the 5 instruments; the 5-lesson instructional plans of Think-Pair-Share and STEM Education Method, students’ learning achievements and their problem solving skills were assessed with the pretest and posttest techniques, students’ outcomes of their instructional the Think-Pair-Share (TPSM) and the STEM Education Methods were compared. Statistically significant was differences with the paired t-test and F-test between posttest and pretest technique of the whole students in chemistry classes were found, significantly. Associations between student learning outcomes in chemistry and two methods of their learning to students’ learning achievements and their problem solving skills also were found. The use of two methods for this study is revealed that the students perceive their learning achievements to their problem solving skills to be differently learning achievements in different groups are guiding practical improvements in chemistry classrooms to assist teacher in implementing effective approaches for improving instructional methods. Students’ learning achievements of mean average scores to their controlling group with the Think-Pair-Share Model (TPSM) are lower than experimental student group for the STEM education method, evidence significantly. The E1/E2 process were revealed evidence of 82.56/80.44, and 83.02/81.65 which results based on criteria are higher than of 80/80 standard level with the IOC, consequently. The predictive efficiency (R2) values indicate that 61% and 67% and indicate that 63% and 67% of the variances in chemistry classes to their learning achievements on posttest in chemistry classes of the variances in students’ problem solving skills to their learning achievements to their chemistry classrooms on Stoichiometry issue with the posttest were attributable to their different learning outcomes for the TPSM and STEMe instructional methods.

Keywords: comparisons, students’ learning achievements, think-pare-share model (TPSM), stem education, problem solving skills, chemistry classes, stoichiometry issue

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Authors: Fatma Ahmed, Heba Mostafa, Bassem Ramdan, Azza El-Soussi

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Background: World Health Organization stated that by 2020 cardiac disease will be the number one cause of death worldwide and estimates that 25 million people per year will suffer from heart disease. Cardiac surgery is considered an effective treatment for severe forms of cardiovascular diseases that cannot be treated by medical treatment or cardiac interventions. In spite of the benefits of cardiac surgery, it is considered a major stressful experience for patients who are candidate for surgery. Prehabilitation can decrease incidences of postoperative complications as it prepares patients for surgical stress through enhancing their defenses to meet the demands of surgery. When patients anticipate the postoperative sequence of events, they will prepare themselves to act certain behaviors, identify their roles and actively participate in their own recovery, therefore, anxiety levels are decreased and functional capacity is enhanced. Prehabilitation programs can comprise interventions that include physical exercise, psychological prehabilitation, nutritional optimization and risk factor modification. Physical exercises are associated with improvements in the functioning of the various physiological systems, reflected in increased functional capacity, improved cardiac and respiratory functions and make patients fit for surgical intervention. Prehabilitation programs should also prepare patients psychologically in order to cope with stress, anxiety and depression associated with postoperative pain, fatigue, limited ability to perform the usual activities of daily living through acting in a healthy manner. Notwithstanding the benefits of psychological preparations, there are limited studies which investigated the effect of psychological prehabilitation to confirm its effect on psychological, quality of life and physiological outcomes of patients who had undergone cardiac surgery. Aim of the study: The study aims to determine the effect of prehabilitation interventions on outcomes of patients undergoing cardiac surgeries. Methods: Quasi experimental study design was used to conduct this study. Sixty eligible and consenting patients were recruited and divided into two groups: control and intervention group (30 participants in each). One tool namely emotional, physiological, clinical, cognitive and functional capacity outcomes of prehabilitation intervention assessment tool was utilized to collect the data of this study. Results: Data analysis showed significant improvement in patients' emotional state, physiological and clinical outcomes (P < 0.000) with the use of prehabilitation interventions. Conclusions: Cardiac prehabilitation in the form of providing information about surgery, circulation exercise, deep breathing exercise, incentive spirometer training and nutritional education implemented daily by patients scheduled for elective open heart surgery one week before surgery have been shown to improve patients' emotional state, physiological and clinical outcomes.

Keywords: emotional recovery, clinical recovery, coronary artery bypass grafting patients, prehabilitation

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Authors: Fahad Qureshi

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This paper provides detailed study on the diagnosis of intermittent high vibration spikes at exhaust bearing (Non-Drive End) of Mitsubishi H-25 gas turbine installed in a petrochemical plant in Pakistan. The diagnosis is followed by successful root cause analysis of the issue and recommendations for improving the reliability of machine. Engro Polymer and Chemicals (EPCL), a Chlor Vinyl complex, has a captive power plant consisting of one combined cycle power plant (CCPP), having two gas turbines each having 25 MW capacity (make: Hitachi) and one extraction condensing steam turbine having 15 MW capacity (make: HTC). Besides, one 6.75 MW SGT-200 1S gas turbine (make: Alstom) is also available. In 2018, the organization faced an issue of intermittent high vibration at exhaust bearing of one of H-25 units having tag GT-2101 A, which eventually led to tripping of machine at configured securities. Since the machine had surpassed 64,000 running hours and major inspection was also due, so bearings inspection was performed. Inspection revealed excessive coke deposition at labyrinth where evidence of rotor rub was also present. Bearing clearance was also at upper limit, and slight babbitt (soft metal) chip off was observed at one of its pads so it was preventively replaced. The unit was restated successfully and exhibited no abnormality until October 2020, when these spikes reoccurred, leading to machine trip. Recurrence of the issue within two years indicated that root cause was not properly addressed, so this paper furthers the discussion on in-depth analysis of findings and establishes successful root cause analysis, which captured significant learnings both in terms of machine design deficiencies and gaps in operation & maintenance (O & M) regime. Lastly, revised O& M regime along with set of recommendations are proposed to avoid recurrence.

Keywords: exhaust side bearing, Gas turbine, rubbing, vibration

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Authors: Alaa Yehia, Ayatollah Yehia, Sherif Yehia

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There is a recurring issue of low enrollments across many civil engineering departments in postsecondary institutions. While there have been moments where enrollments begin to increase, civil engineering departments find themselves facing low enrollments at around 60% over the last five years across the Middle East. There are many reasons that could be attributed to this decline, such as low entry-level salaries, over-saturation of civil engineering graduates in the job market, and a lack of construction projects due to the impending or current recession. However, this recurring problem alludes to an intrinsic issue of the curriculum. The societal shift to the usage of high technology such as machine learning (ML) and artificial intelligence (AI) demands individuals who are proficient at utilizing it. Therefore, existing curriculums must adapt to this change in order to provide an education that is suitable for potential and current students. In this paper, In order to provide potential solutions for this issue, the analysis considers two possible implementations of high technology into the civil engineering curriculum. The first approach is to implement a course that introduces applications of high technology in Civil Engineering contexts. While the other approach is to intertwine applications of high technology throughout the degree. Both approaches, however, should meet requirements of accreditation agencies. In addition to the proposed improvement in civil engineering curriculum, a different pedagogical practice must be adapted as well. The passive learning approach might not be appropriate for Gen Z students; current students, now more than ever, need to be introduced to engineering topics and practice following different learning methods to ensure they will have the necessary skills for the job market. Different learning methods that incorporate high technology applications, like AI, must be integrated throughout the curriculum to make the civil engineering degree more attractive to prospective students. Moreover, the paper provides insight on the importance and approach of adapting the Civil Engineering curriculum to address the current low enrollment crisis that civil engineering departments globally, but specifically in the Middle East, are facing.

Keywords: artificial intelligence (AI), civil engineering curriculum, high technology, low enrollment, pedagogy

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Authors: Monika Moggert

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The aim of the research evaluates the local centers' development of Berlin, the capital of Germany. There are included studies of their potential, considers the possibility of applying different cultural influences and the issue of the current demographic transformation of Europe. The solution utilizes the analysis of historical, cultural, political and sociological changes after 2nd World War; the exploration of historical as well as strategic maps and personal evaluation of the current condition of selected boroughs – Berlin Neuköln, Kreuzberg and Wedding, where more than 30% of the inhabitants have a migration background. The research provides an example of the likely development of centers in urban agglomerations. It examines the issue of local centers with an inhumane scale in contrast to small-scale centering sites, mostly located in areas largely with immigrant communities. The research results enable a better understanding of the influence of different cultures and lifestyles on the appearance of the city and its local centers. We can use it as an inspiration for the new design of the Berlin centers. The results will be used for further research on urban space development in the cultural environment of Europe and the Middle East as well.

Keywords: Berlin, cultural environment, life in the city, public and urban space, the urban city centers development, town and society

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Authors: Yih-Jer Wu, Ling-Lang Huang

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Shared decision-making (SDM) is a critical aspect of determining optimal medical strategies. However, current patient decision aids (PDAs) often prioritize evidence-based discussions over value-based considerations. Despite its significance, there is limited research addressing the 'value gap' between patients and healthcare providers. To address this gap, we developed the 'Patient-Doctor Relationship Questionnaire,' consisting of 12 questions. To explore potential variations in the patient-doctor value gap across different medical specialties, we conducted interviews with physicians, surgeons, and their respective patients, utilizing the questionnaire. Between 2020 and 2022, we interviewed a total of 144 patients and 19 doctors. Among the 12 questions, physicians demonstrated significant patient-doctor value gaps in 5 questions, while surgeons in 3 questions. Only one question turned out significant gaps in both physicians and surgeons. When asking both doctors and their patients to choose one from the following 6 answers (1. No issue significant; 2. Not knowing how to make a medical decision; 3. Not confident in the doctor’s clinical judgment; 4. Not knowing how to articulate one’s own condition; 5. Unable to afford medical expenses; 6. Not understanding what doctors explain) in response to the question “what the most significant issue is in the medical consultation”, over 50% of doctors chose “Not knowing how to make a medical decision” (physicians vs. patients, 50% vs. 11%, p=0.046; surgeon vs. patients, 83% vs. 29%, p=0.001), while significantly more patients chose “No issue significant” (10% vs. 52%, p=0.002; 0% vs. 33%, p<0.001, respectively). Our findings indicate that value gaps do exist between patients and doctors and that most patients in Taiwan "fully trust" their doctors' recommendations for medical decisions. However, when treatment outcomes are far from ideal, this overinflated "trust" may turn into frustration, which could become the catalyst for medical disputes. Doctors should spend more time having more effective communication with their patients, particularly regarding potentially dissatisfactory treatment outcomes. This study underscores the substantial variability in the patient-doctor value gap, often overlooked in SDM. Patients from different clinical backgrounds may hold values distinct from those of their healthcare providers. Bridging this value gap is imperative for achieving genuine and effective SDM.

Keywords: share-decision making, value gaps, communication, doctor-patient relationship

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Authors: Hyun Chang Kim, Yong Hun Jung, Kyung Woon Jeung

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Background: From the viewpoint of cardiac pump theory, the area of the left ventricle (LV) subjected to compression increases as the LV lies closer to the sternum, possibly resulting in higher blood flow in patients with LV closer to the sternum. However, no study has evaluated LV position during cardiac arrest or its relationship with hemodynamic parameters during cardiopulmonary resuscitation (CPR). The objectives of this study were to determine whether the position of the LV relative to the anterior-posterior axis representing the direction of chest compression shifts during cardiac arrest and to examine the relationship between LV position and hemodynamic parameters during CPR. Methods: Subcostal view echocardiograms were obtained from 15 pigs with the transducer parallel to the long axis of the sternum before inducing ventricular fibrillation (VF) and during cardiac arrest. Computed tomography was performed in three pigs to objectively observe LV position during cardiac arrest. LV position parameters including the shortest distance between the anterior-posterior axis and the mid-point of the LV chamber (DAP-MidLV), the shortest distance between the anterior-posterior axis and the LV apex (DAP-Apex), and the area fraction of the LV located on the right side of the anterior-posterior axis (LVARight/LVATotal) were measured. Results: DAP-MidLV, DAP-Apex, and LVARight/LVATotal decreased progressively during untreated VF and basic life support (BLS), and then increased during advanced cardiovascular life support (ACLS). A repeated measures analysis of variance revealed significant time effects for these parameters. During BLS, the end-tidal carbon dioxide and systolic right atrial pressure were significantly correlated with the LV position parameters. During ACLS, systolic arterial pressure and systolic right atrial pressure were significantly correlated with DAP-MidLV and DAP-Apex. Conclusions: LV position changed significantly during cardiac arrest compared to the pre-arrest baseline. LV position during CPR had significant correlations with hemodynamic parameters.

Keywords: heart arrest, cardiopulmonary resuscitation, heart ventricle, hemodynamics

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Authors: Mustapha Hedabou, Ali Azougaghe, Ahmed Bentajer, Hicham Boukhris, Mourad Eddiwani, Zakaria Igarramen

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Software-as-a-service (SaaS) is emerging as a dominant approach to delivering software. It encompasses a range of business, technical opportunities, issue, and challenges. Trustiness in the cloud services regarding the security and the privacy of the delivered data is the most critical issue with the SaaS model. In this paper, we survey the security concerns related to the SaaS model, and we propose the design of a trusted SaaS model that gives users more confidence into SaaS services by leveraging a trust in a neutral source code certifying authority. The proposed design is based on the use of the multisignature mechanism for signing the source code of the application service. In our model, the cloud provider acts as a root of trust by ensuring the integrity of the application service when it was running on its platform. The proposed design prevents insider attacks from tampering with application service before and after it was launched in a cloud provider platform.

Keywords: cloud computing, SaaS Platform, TPM, trustiness, code source certification, multi-signature schemes

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Authors: Tarcisio F. Leao, Bruno Utiyama, Jeison Fonseca, Eduardo Bock, Aron Andrade

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This work presents a blood flow estimator based in Look-Up-Table (LUT) for control of Left Ventricular Assist Device (LVAD). This device has been used as bridge to transplantation or as destination therapy to treat patients with heart failure (HF). Destination Therapy application requires a high performance LVAD; thus, a stable control is important to keep adequate interaction between heart and device. LVAD control provides an adequate cardiac output while sustaining an appropriate flow and pressure blood perfusion, also described as physiologic control. Because thrombus formation and system reliability reduction, sensors are not desirable to measure these variables (flow and pressure blood). To achieve this, control systems have been researched to estimate blood flow. LVAD used in the study is composed by blood centrifugal pump, control, and power supply. This technique used pump and actuator (motor) parameters of LVAD, such as speed and electric current. Estimator relates electromechanical torque (motor or actuator) and hydraulic power (blood pump) via LUT. An in vitro Mock Loop was used to evaluate deviations between blood flow estimated and actual. A solution with glycerin (50%) and water was used to simulate the blood viscosity with hematocrit 45%. Tests were carried out with variation hematocrit: 25%, 45% and 58% of hematocrit, or 40%, 50% and 60% of glycerin in water solution, respectively. Test with bovine blood was carried out (42% hematocrit). Mock Loop is composed: reservoir, tubes, pressure and flow sensors, and fluid (or blood), beyond LVAD. Estimator based in LUT is patented, number BR1020160068363, in Brazil. Mean deviation is 0.23 ± 0.07 L/min for mean flow estimated. Larger mean deviation was 0.5 L/min considering hematocrit variation. This estimator achieved deviation adequate for physiologic control implementation. Future works will evaluate flow estimation performance in control system of LVAD.

Keywords: blood pump, flow estimator, left ventricular assist device, look-up-table

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Authors: Jana Kožárová

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Even the behavior problems in pre-school children might be considered as a transitional problem which may disappear by their transition into elementary school; it is an issue that needs a lot of attention because of the fact that the behavioral patterns are adopted in the children especially in this age. Common issue in the process of elimination of the behavior problems in the group of pre-school children is a difference in the perception of the importance and gravity of the symptoms. The underestimation of the children's problems by parents often result into conflicts with kindergarten teachers. Thus, the child does not get the support that his/her problems require and this might result into a school failure and can negatively influence his/her future school performance and success. The research sample consisted of 4 children with behavior problems, their teachers and parents. To determine the most problematic area in the child's behavior, Child Behavior Checklist (CBCL) filled by parents and Caregiver/Teacher Form (CTF-R) filled by teachers were used. Scores from the CBCL and the CTR-F were compared with Pearson correlation coefficient in order to find the differences in the perception of behavior problems in pre-school children.

Keywords: behavior problems, Child Behavior Checklist, Caregiver/Teacher Form, Pearson correlation coefficient, pre-school age

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