Search results for: cancer risk assessment

Authors: Salvador Garcia Bernal, Chi Zheng, Keqi Zhang, Lei Mao

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Circulating Tumor Cells (CTC) is used to detect tumoral cell metastases using blood samples of patients with cancer (lung, breast, etc.). Using an immunofluorescent method a three channel image (Red, Green, and Blue) are obtained. These set of images usually overpass the 11 x 30 M pixels in size. An aided tool is designed for imaging cell analysis to segmented and identify the tumorous cell based on the three markers signals. Our Method, it is cell-based (area and cell shape) considering each channel information and extracting and making decisions if it is a valid CTC. The system also gives information about number and size of tumor cells found in the sample. We present results in real-life samples achieving acceptable performance in identifying CTCs in short time.

Keywords: Circulating Tumor Cells (CTC), cell analysis, immunofluorescent, medical image analysis

Procedia PDF Downloads 207

Authors: Padma Chutoo, Elena Kulinskaya, Ilyas Bakbergenuly, Nicholas Steel, Dmitri Pchejetski

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Stroke is associated with a significant risk of morbidity and mortality. There is scarcity of research on the long-term survival after first-ever ischaemic stroke (IS) events in England with regards to effects of different medical therapies and comorbidities. The objective of this study was to model the all-cause mortality after an IS diagnosis in the adult population of England. Using a retrospective case-control design, we extracted the electronic medical records of patients born prior to or in year 1960 in England with a first-ever ischaemic stroke diagnosis from January 1986 to January 2017 within the Health and Improvement Network (THIN) database. Participants with a history of ischaemic stroke were matched to 3 controls by sex and age at diagnosis and general practice. The primary outcome was the all-cause mortality. The hazards of the all-cause mortality were estimated using a Weibull-Cox survival model which included both scale and shape effects and a shared random effect of general practice. The model included sex, birth cohort, socio-economic status, comorbidities and medical therapies. 20,250 patients with a history of IS (cases) and 55,519 controls were followed up to 30 years. From 2008 to 2015, the one-year all-cause mortality for the IS patients declined with an absolute change of -0.5%. Preventive treatments to cases increased considerably over time. These included prescriptions of statins and antihypertensives. However, prescriptions for antiplatelet drugs decreased in the routine general practice since 2010. The survival model revealed a survival benefit of antiplatelet treatment to stroke survivors with hazard ratio (HR) of 0.92 (0.90 – 0.94). IS diagnosis had significant interactions with gender and age at entry and hypertension diagnosis. IS diagnosis was associated with high risk of all-cause mortality with HR= 3.39 (3.05-3.72) for cases compared to controls. Hypertension was associated with poor survival with HR = 4.79 (4.49 - 5.09) for hypertensive cases relative to non-hypertensive controls, though the detrimental effect of hypertension has not reached significance for hypertensive controls, HR = 1.19(0.82-1.56). This study of English primary care data showed that between 2008 and 2015, the rates of prescriptions of stroke preventive treatments increased, and a short-term all-cause mortality after IS stroke declined. However, stroke resulted in poor long-term survival. Hypertension, a modifiable risk factor, was found to be associated with poor survival outcomes in IS patients. Antiplatelet drugs were found to be protective to survival. Better efforts are required to reduce the burden of stroke through health service development and primary prevention.

Keywords: general practice, hazard ratio, health improvement network (THIN), ischaemic stroke, multiple imputation, Weibull-Cox model.

Procedia PDF Downloads 178

Authors: Minjeong Kim, Seungchul Lee, Iman Janghorban Esfahani, Jeong Tai Kim, ChangKyoo Yoo

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A trajectory of set-point of ventilation control systems plays an important role for efficient ventilation inside subway stations since it affects the level of indoor air pollutants and ventilation energy consumption. To maintain indoor air quality (IAQ) at a comfortable range with lower ventilation energy consumption, the optimal trajectory of the ventilation control system needs to be determined. The concentration of air pollutants inside the station shows a diurnal variation in accordance with the variations in the number of passengers and subway frequency. To consider the diurnal variation of IAQ, an iterative dynamic programming (IDP) that searches for a piecewise control policy by separating whole duration into several stages is used. When outdoor air is contaminated by pollutants, it enters the subway station through the ventilation system, which results in the deteriorated IAQ and adverse effects on passenger health. In this study, to consider the influence of outdoor air quality (OAQ), a new performance index of the IDP with the passenger health risk and OAQ is proposed. This study was carried out for an underground subway station at Seoul Metro, Korea. The optimal set-points of the ventilation control system are determined every 3 hours, then, the ventilation controller adjusts the ventilation fan speed according to the optimal set-point changes. Compared to manual ventilation system which is operated irrespective of the OAQ, the IDP-based ventilation control system saves 3.7% of the energy consumption. Compared to the fixed set-point controller which is operated irrespective of the IAQ diurnal variation, the IDP-based controller shows better performance with a 2% decrease in energy consumption, maintaining the comfortable IAQ range inside the station.

Keywords: indoor air quality, iterative dynamic algorithm, outdoor air information, ventilation control system

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Authors: Manfred Szerencsits, Christine Weinberger, Maximilian Kuderna, Franz Feichtinger, Eva Erhart, Stephan Maier

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Cover or catch crops have beneficial effects for soil, water, erosion, etc. If harvested, they also provide feedstock for biogas without competition for arable land in regions, where only one main crop can be produced per year. On average gross energy yields of approx. 1300 m³ methane (CH₄) ha^-1 can be expected from 4.5 tonnes (t) of cover crop dry matter (DM) in Austria. Considering the total energy invested from cultivation to compression for biofuel use a net energy yield of about 1000 m³ CH₄ ha^-1 is remaining. With the straw of grain maize or Corn Cob Mix (CCM) similar energy yields can be achieved. In comparison to catch crops remaining on the field as green manure or to complete fallow between main crops the effects on soil, water and climate can be improved if cover crops are harvested without soil compaction and digestate is returned to the field in an amount equivalent to cover crop removal. In this way, the risk of nitrate leaching can be reduced approx. by 25% in comparison to full fallow. The risk of nitrous oxide emissions may be reduced up to 50% by contrast with cover crops serving as green manure. The effects on humus content and erosion are similar or better than those of cover crops used as green manure when the same amount of biomass was produced. With higher biomass production the positive effects increase even if cover crops are harvested and the only digestate is brought back to the fields. The ecological footprint of arable farming can be reduced by approx. 50% considering the substitution of natural gas with CH₄ produced from cover crops.

Keywords: biogas, cover crops, catch crops, land use competition, sustainable agriculture

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Authors: A van Onselen, C. M. Walsh, F. J. Veldman, C. Brand

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Objectives: To determine the nutritional status and risk factors associated with women practicing geophagia in QwaQwa, South Africa. Materials and Methods: An observational epidemiological study design was adopted which included an exposed (geophagia) and non-exposed (control) group. A food frequency questionnaire, anthropometric measurements and blood sampling were applied to determine nutritional status of participants. Logistic regression analysis was performed in order to identify factors that were likely to be associated with the practice of geophagia. Results: The mean total energy intake for the geophagia group (G) and control group(C) were 10324.31 ± 2755.00 kJ and 10763.94 ± 2556.30 kJ respectively. Both groups fell within the overweight category according to the mean body mass index (BMI) of each group (G= 25.59 kg/m2; C= 25.14 kg/m2). The mean serum iron levels of the geophagia group (6.929 μmol/l) were significantly lower than that of the control group (13.75 μmol/l) (p = 0.000). Serum transferrin (G=3.23g/l; C=2.7054g/l) and serum transferrin saturation (G=8.05%; C=18.74%) levels also differed significantly between groups (p=0.00). Factors that were associated with the practice of geophagia included haemoglobin (Odds ratio (OR):14.50), serum-iron (OR: 9.80), serum-ferritin (OR: 3.75), serum-transferrin (OR: 6.92) and transferrin saturation (OR: 14.50). A significant negative association (p=0.014) was found between women who were wage-earners and those who were not wage-earners and the practice of geophagia (OR: 0.143; CI: 0.027; 0.755). These findings seem to indicate that a permanent income may decrease the likelihood of practising geophagia. Key findings: Geophagia was confirmed to be a risk factor for iron deficiency in this community. The significantly strong association between geophagia and iron deficiency emphasizes the importance of identifying the practice of geophagia in women, especially during their child bearing years. Further research to establish whether the practice of geophagia is a cause of iron-deficiency, or whether it is the consequence thereof, would give a clearer view on how to recognise and treat the condition.

Keywords: geophagia, iron deficiency anaemia, dietary intake, anthropometry

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Authors: Anthony R. Townsend, Robyn L. Fasser

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This research project provides an interpretative phenomenological analysis of a proposed conceptual model of parenting ability that has been designed to offer recommendations to guide intervention in child custody evaluations in South Africa. A recent review of the literature on child custody evaluations reveals that while there have been significant and valuable shifts in the capacity of the legal system aided by mental health professionals in understanding children and family dynamics, there remains a conceptual gap regarding the nature of parenting ability. With a view to addressing this paucity of a theoretical basis for considering parenting ability, this research project reviews a dimensional model for the assessment of parenting ability by conceiving parenting ability as a combination of good parenting and parental fitness. This model serves as a conceptual framework to guide child-custody evaluation and refine intervention in such cases to better meet the best interests of the child in a manner that bridges the professional gap between parties, legal entities, and mental health professionals. Using a model of good parenting as a point of theoretical departure, this model incorporates both intra-psychic and interpersonal attributes and behaviours of parents to form an impression of parenting ability and identify areas for potential enhancement. This research, therefore, hopes to achieve the following: (1) to provide nuanced descriptions of parents’ parenting ability; (2) to describe parents’ parenting potential; (3) to provide a parenting assessment tool for investigators in forensic family matters that will enable more useful recommendations and interventions; (4) to develop a language of consensus for investigators, attorneys, judges and parents, in forensic family matters, as to what comprises parenting ability and how this can be assessed; and (5) that all of the aforementioned will serve to advance the best interests of the children involved in such litigious matters. The evaluative promise and post-assessment prospects of this model are illustrated through three interlinking data sets: (1) the results of interviews with South African psychologists about the model, (2) retrospective analysis of care and contact evaluation reports using the model to determine if different conclusions or more specific recommendations are generated with its use and (3) the results of an interview with a psychologist who piloted this model by using it in care and contact evaluation.

Keywords: alienation, attachment, best interests of the child, care and contact evaluation, children’s act (38 of 2005), child custody evaluation, civil forensics, gatekeeping, good parenting, good-enough parenting, health professions council of South Africa, family law, forensic mental healthcare practitioners, parental fitness, parenting ability, parent management training, parenting plan, problem-determined system, psychotherapy, support of other child-parent relationship, voice of the child

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Authors: Muhammet Kurucu, Sahabettin Ozturk, Soner Guler

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Varagavank monastery is one of the most important symbols of Van city. In time, because of it hosted sacred memories, Varagavank monastery has become a great place with additional churches and chapels. A large part of contemporary spaces in the main building of the Varagavank monastery are now under ground. In addition to this, many parts of this structure have been destroyed by humanity and natural disasters. In this study, present condition of the Varagavank monastery are observed and debated in detail.

Keywords: Van city, seven churches, chapel, natural disasters

Procedia PDF Downloads 284

Authors: Reem Osama Yousif Ali, Osama Yousif Ali Al Gibali

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Introduction: Balanced nutrition is undeniably essential for maintaining health, body functions, and integrity of cell metabolism; however, some sick patients cannot tolerate oral or enteral feeding to meet their nutritional needs, so partial or total parenteral nutrition (PN) may be the most suitable alternative route in such situations. Dietitians are fundamental personnel among the medical team to ensure the proper provision of PN service, which was introduced in Sudan in the 1980s. Objective: The study aimed to recognize the dietitians' awareness of parenteral nutrition and their role in providing this service in Sudan – Khartoum State. Methodology: Formulated questionnaire forms composed of twelve questions were distributed to the dietitians working in four tertiary level hospitals. Results: The majority (75%) of the responded dietitians had reasonable knowledge about the importance of PN, its advantages, and its indications. Sixty percent of them were mindful of the PN side effects. Most of the dietitians were aware of the different assessment measurements and PN calculations and were exposed in their clinical practice to patients who were in need of PN, but only a few of them (about 30%) had the actual chance to participate in the formulation and application of PN therapy. The unavailability of the multidisciplinary team, lack of the required equipment and financial support, and associated complications were basic obstacles to the provision of long-term PN service in Khartoum state hospitals. Conclusion: Although dietitians in Khartoum state hospitals have good information about PN definition, indications, accesses, and assessment measures, they do not have enough knowledge and clinical exposure that make them confident to provide the PN service. Establishing a few models of parenteral nutrition units in tertiary hospitals will be of great help, as well as providing the dietitian's training in the area of parenteral nutrition. Further study can explore more requirements to run this service.

Keywords: nutrition support, dietitian, Sudan, parenteral nutrition, nutrition support team

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Authors: Manavjit Singh Dhindsa, Ursula Das, Kshirasagar Naik, Marzia Zaman, Richard Purcell, Srinivas Sampalli, Abdul Mutakabbir, Chung-Horng Lung, Thambirajah Ravichandran

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These days, wildland fires, also known as forest fires, are more prevalent than ever. Wildfires have major repercussions that affect ecosystems, communities, and the environment in several ways. Wildfires lead to habitat destruction and biodiversity loss, affecting ecosystems and causing soil erosion. They also contribute to poor air quality by releasing smoke and pollutants that pose health risks, especially for individuals with respiratory conditions. Wildfires can damage infrastructure, disrupt communities, and cause economic losses. The economic impact of firefighting efforts, combined with their direct effects on forestry and agriculture, causes significant financial difficulties for the areas impacted. This research explores different forest fire spread models and presents a comprehensive review of various techniques and methodologies used in the field. A forest fire spread model is a computational or mathematical representation that is used to simulate and predict the behavior of a forest fire. By applying scientific concepts and data from empirical studies, these models attempt to capture the intricate dynamics of how a fire spreads, taking into consideration a variety of factors like weather patterns, topography, fuel types, and environmental conditions. These models assist authorities in understanding and forecasting the potential trajectory and intensity of a wildfire. Emphasizing the need for a comprehensive understanding of wildfire dynamics, this research explores the approaches, assumptions, and findings derived from various models. By using a comparison approach, a critical analysis is provided by identifying patterns, strengths, and weaknesses among these models. The purpose of the survey is to further wildfire research and management techniques. Decision-makers, researchers, and practitioners can benefit from the useful insights that are provided by synthesizing established information. Fire spread models provide insights into potential fire behavior, facilitating authorities to make informed decisions about evacuation activities, allocating resources for fire-fighting efforts, and planning for preventive actions. Wildfire spread models are also useful in post-wildfire mitigation strategies as they help in assessing the fire's severity, determining high-risk regions for post-fire dangers, and forecasting soil erosion trends. The analysis highlights the importance of customized modeling approaches for various circumstances and promotes our understanding of the way forest fires spread. Some of the known models in this field are Rothermel’s wildland fuel model, FARSITE, WRF-SFIRE, FIRETEC, FlamMap, FSPro, cellular automata model, and others. The key characteristics that these models consider include weather (includes factors such as wind speed and direction), topography (includes factors like landscape elevation), and fuel availability (includes factors like types of vegetation) among other factors. The models discussed are physics-based, data-driven, or hybrid models, also utilizing ML techniques like attention-based neural networks to enhance the performance of the model. In order to lessen the destructive effects of forest fires, this initiative aims to promote the development of more precise prediction tools and effective management techniques. The survey expands its scope to address the practical needs of numerous stakeholders. Access to enhanced early warning systems enables decision-makers to take prompt action. Emergency responders benefit from improved resource allocation strategies, strengthening the efficacy of firefighting efforts.

Keywords: artificial intelligence, deep learning, forest fire management, fire risk assessment, fire simulation, machine learning, remote sensing, wildfire modeling

Procedia PDF Downloads 76

Authors: Saeed Nazari, Masoom Nazari, Ali Hejazi, Siamak Sanoobari Ghazi Jahani, Mohammad Dehghani, Javad Vakili

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More than ever, digitization is an imperative for businesses to keep their competitive advantages, foster innovation and reduce paperwork. To design and successfully implement digital transformation initiatives within process safety management system, employees need to be equipped with the right tool, frameworks, and best practices. we developed a unique full stack application so-called SHEQTool which is entirely dynamic based on our extensive expertise, experience, and client feedback to help business processes particularly operations safety management. We use our best knowledge and scientific methodologies published by CCPS and OSHA Guidelines to streamline operations and integrated them into task management within Petrochemical Companies. We digitalize their main process safety management system elements and their sub elements such as hazard identification and risk management, training and communication, inspection and audit, critical changes management, contractor management, permit to work, pre-start-up safety review, incident reporting and investigation, emergency response plan, personal protective equipment, occupational health, and action management in a fully customizable manner with no programming needs for users. We review the feedback from main actors within petrochemical plant which highlights improving their business performance and productivity as well as keep tracking their functions’ key performance indicators (KPIs) because it; 1) saves time, resources, and costs of all paperwork on our businesses (by Digitalization); 2) reduces errors and improve performance within management system by covering most of daily software needs of the organization and reduce complexity and associated costs of numerous tools and their required training (One Tool Approach); 3) focuses on management systems and integrate functions and put them into traceable task management (RASCI and Flowcharting); 4) helps the entire enterprise be resilient to any change of your processes, technologies, assets with minimum costs (through Organizational Resilience); 5) reduces significantly incidents and errors via world class safety management programs and elements (by Simplification); 6) gives the companies a systematic, traceable, risk based, process based, and science based integrated management system (via proper Methodologies); 7) helps business processes complies with ISO 9001, ISO 14001, ISO 45001, ISO 31000, best practices as well as legal regulations by PDCA approach (Compliance).

Keywords: process, safety, digitalization, management, risk, incident, SHEQTool, OSHA, CCPS

Procedia PDF Downloads 55

Authors: María-Dolores Olvera-Lobo, Bryan John Robinson, Juncal Gutierrez-Artacho

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Graduates are equipped with a wide range of generic competencies which complement solid curricular competencies and facilitate their access to the labour market in diverse fields and careers. However, some generic competencies such as instrumental, personal and systemic competencies related to teamwork and interpersonal communication skills, decision-making and organization skills are seldom taught explicitly and even less often assessed. In this context, translator training has embraced a broad range of competencies specified in the undergraduate program currently taught at universities and opens up the learning experience to cover areas often ignored due to the difficulties inherent in both teaching and assessment. In practice, translator training combines two well-established approaches to teaching/learning: project-based learning and genuinely cooperative – or merely collaborative – learning. Our professional approach to translator training is a model focused on and adapted to the teleworking context of professional translation and presented through the medium of blended e-learning. Teamwork-related competencies are extremely relevant, and they require explicit and implicit teaching so that graduates can be confident about their capacity to make their way in professional contexts. In order to highlight the importance of teamwork and intra-team relationships beyond the classroom, we aim to raise awareness of teamwork processes so as to empower translation students in managing their interaction and ensure that they gain valuable pre-professional experience. With these objectives, at the University of Granada (Spain) we have developed a range of classroom activities and assessment tools. The results of their application are summarized in this study.

Keywords: blended learning, collaborative teamwork, cross-curricular competencies, higher education, intra-team relationships, students’ perceptions, translator training

Procedia PDF Downloads 163

Authors: Matthew I. Bellgard

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The field of bioinformatics has made, and continues to make, substantial progress and contributions to life science research and development. However, this paper contends that a systems approach integrates bioinformatics activities for any project in a defined manner. The application of critical control points in this bioinformatics systems approach may be useful to identify and evaluate points in a pathway where specified activity risk can be reduced, monitored and quality enhanced.

Keywords: bioinformatics, food security, personalized medicine, systems approach

Procedia PDF Downloads 418

Authors: A. Ramachandra Reddy, V. Murugan, Prema Kumari

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Residual solvents in Pharmaceutical samples are monitored using gas chromatography with headspace (GC-HS). Based on current regulatory and compendial requirements, measuring the residual solvents are mandatory for all release testing of active pharmaceutical ingredients (API). Generally, isopropyl alcohol is used as the residual solvent in proline and tryptophan; methanol in cysteine monohydrate hydrochloride, glycine, methionine and serine; ethanol in glycine and lysine monohydrate; acetic acid in methionine. In order to have a single method for determining these residual solvents (isopropyl alcohol, ethanol, methanol and acetic acid) in all these 7 amino acids a sensitive and simple method was developed by using gas chromatography headspace technique with flame ionization detection. During development, no reproducibility, retention time variation and bad peak shape of acetic acid peaks were identified due to the reaction of acetic acid with the stationary phase (cyanopropyl dimethyl polysiloxane phase) of column and dissociation of acetic acid with water (if diluent) while applying temperature gradient. Therefore, dimethyl sulfoxide was used as diluent to avoid these issues. But most the methods published for acetic acid quantification by GC-HS uses derivatisation technique to protect acetic acid. As per compendia, risk-based approach was selected as appropriate to determine the degree and extent of the validation process to assure the fitness of the procedure. Therefore, Total error concept was selected to validate the analytical procedure. An accuracy profile of ±40% was selected for lower level (quantitation limit level) and for other levels ±30% with 95% confidence interval (risk profile 5%). The method was developed using DB-Waxetr column manufactured by Agilent contains 530 µm internal diameter, thickness: 2.0 µm, and length: 30 m. A constant flow of 6.0 mL/min. with constant make up mode of Helium gas was selected as a carrier gas. The present method is simple, rapid, and accurate, which is suitable for rapid analysis of isopropyl alcohol, ethanol, methanol and acetic acid in amino acids. The range of the method for isopropyl alcohol is 50ppm to 200ppm, ethanol is 50ppm to 3000ppm, methanol is 50ppm to 400ppm and acetic acid 100ppm to 400ppm, which covers the specification limits provided in European pharmacopeia. The accuracy profile and risk profile generated as part of validation were found to be satisfactory. Therefore, this method can be used for testing of residual solvents in amino acids drug substances.

Keywords: amino acid, head space, gas chromatography, total error

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Authors: Tim J. Walsh, Lindsay E. Young, John A. Schneider

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Background: The disproportionate rate of HIV infection among Black men who have sex with men (BMSM) in the United States suggest the importance of Preexposure Prophylaxis (PrEP) interventions for this population. As such, there is an urgent need for innovative outreach strategies that extend beyond the traditional patient-provider relationship to reach at-risk populations. Training members of the BMSM community as peer change agents (PCAs) is one such strategy. An important piece of this training is goal-setting. Goal-setting not only encourages PCAs to define the parameters of the intervention according to their lived experience, it also helps them plan courses of action. Therefore, the aims of this mixed methods study are: (1) Characterize the goals that BMSM set at the end of their PrEP training and (2) Assess the relationship between goal types and PCA engagement. Methods: Between March 2016 and July 2016, preliminary data were collected from 68 BMSM, ages 18-33, in Chicago as part of an ongoing PrEP intervention. Once enrolled, PCAs participate in a half-day training in which they learn about PrEP, practice initiating conversations about PrEP, and identify strategies for supporting at-risk peers through the PrEP adoption process. Training culminates with a goal-setting exercise, whereby participants establish a goal related to their role as a PCA. Goals were coded for features that either emerged from the data itself or existed in extant goal-setting literature. The main outcomes were (1) number of PrEP conversations PCAs self-report during booster conversations two weeks following the intervention and (2) number of peers PCAs recruit into the study that completed the PrEP workshop. Results: PCA goals (N=68) were characterized in terms of four features: Specificity, target population, personalization, and purpose defined. To date, PCAs report a collective 52 PrEP conversations. 56, 25, and 6% of PrEP conversations occurred with friends, family, and sexual partners, respectively. PCAs with specific goals had more PrEP conversations with at-risk peers compared to those with vague goals (58% vs. 42%); PCAs with personalized goals had more PrEP conversations compared to those with de-personalized goals (60% vs. 53%); and PCAs with goals that defined a purpose had more PrEP conversations compared to those who did not define a purpose (75% vs. 52%). 100% of PCAs with goals that defined a purpose recruited peers into the study compared to 45 percent of PCAs with goals that did not define a purpose. Conclusion: Our preliminary analysis demonstrates that BMSM are motivated to set and work toward a diverse set of goals to support peers in PrEP adoption. PCAs with goals involving a clearly defined purpose had more PrEP conversations and greater peer recruitment than those with goals lacking a defined purpose. This may indicate that PCAs who define their purpose at the outset of their participation will be more engaged in the study than those who do not. Goal-setting may be considered as a component of future HIV prevention interventions to advance intervention goals and as an indicator of PCAs understanding of the intervention.

Keywords: HIV prevention, MSM, peer change agent, preexposure prophylaxis

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Authors: Marija Vitanovа, Igor Gjorgjiev, Viktor Hristovski, Vlado Micov

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Evaluation of stability is very important in the process of definition of optimal structural measures for maintenance of bridge structures and their strengthening. To define optimal measures for their repair and strengthening, it is necessary to evaluate their static and seismic stability. Presented in this paper are methodologies for evaluation of the seismic stability of existing reinforced concrete bridges designed without consideration of seismic effects and checking of structural justification of newly designed bridge structures. All bridges are located in the territory of the Republic of North Macedonia. A total of 26 existing bridges of different structural systems have been analyzed. Visual inspection has been carried out for all bridges, along with the definition of three main damage categories according to which structures have been categorized in respect to the need for their repair and strengthening. Investigations involving testing the quality of the built-in materials have been carried out, and dynamic tests pointing to the dynamic characteristics of the structures have been conducted by use of non-destructive methods of ambient vibration measurements. The conclusions drawn from the performed measurements and tests have been used for the development of accurate mathematical models that have been analyzed for static and dynamic loads. Based on the geometrical characteristics of the cross-sections and the physical characteristics of the built-in materials, interaction diagrams have been constructed. These diagrams along with the obtained section quantities under seismic effects, have been used to obtain the bearing capacity of the cross-sections. The results obtained from the conducted analyses point to the need for the repair of certain structural parts of the bridge structures. They indicate that the stability of the superstructure elements is not critical during a seismic effect, unlike the elements of the sub-structure, whose strengthening is necessary.

Keywords: existing bridges, newly designed bridges, reinforced concrete bridges, stability assessment

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Authors: Tan Lay Cheng (Cheryl), Low Huiqi

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Background: All children learn at different pace. Individualized learning is an approach that tailors to the individual learning needs of each child. When implementing this approach, educators have to base their lessons on the understanding that all students learn differently and that what works for one student may not work for another. In the current early childhood environment, individualized learning is for children with diverse needs. However, a typical developing child is also able to benefit from individualized learning. This research abstract explores the concept of utilizing DNA-MILE, a patented (in Singapore) DNA-based assessment tool that can be used to measure a variety of factors that can impact learning. The assessment report includes the dominant intelligence of the user or, in this case, the child. From the result, a personalized learning plan that is tailored to each individual student's needs. Methods: A study will be conducted to investigate the effectiveness of DNA-MILE in supporting individualized learning. The study will involve a group of 20 preschoolers who were randomly assigned to either a DNA-MILE-assessed group (experimental group) or a control group. 10 children in each group. The experimental group will receive DNA Mile assessments and personalized learning plans, while the control group will not. The children in the experimental group will be taught using the dominant intelligence (as shown in the DNA-MILE report) to enhance their learning in other domains. The children in the control group will be taught using the curriculum and lesson plan set by their teacher for the whole class. Parents’ and teachers’ interviews will be conducted to provide information about the children before the study and after the study. Results: The results of the study will show the difference in the outcome of the learning, which received DNA Mile assessments and personalized learning plans, significantly outperformed the control group on a variety of measures, including standardized tests, grades, and motivation. Conclusion: The results of this study suggest that DNA Mile can be an effective tool for supporting individualized learning. By providing personalized learning plans, DNA Mile can help to improve learning outcomes for all students.

Keywords: individualized, DNA-MILE, learning, preschool, DNA, multiple intelligence

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Authors: Carine Platat, Fatima Qshadi, Ghofran Kayed, Nour Hussein, Amjad Jarrar, Habiba Ali

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Nowadays, smartphones are very popular. They are offering a variety of easy-to-use and free applications among which step counters and fitness tests. The number of users is huge making of such applications a potentially efficient new strategy to encourage people to become more active. Nonetheless, data on their reliability and validity are very scarce and when available, they are often negative and contradictory. Besides, weight status, which is likely to introduce a bias in the physical activity assessment, was not often considered. Hence, the use of these applications as motivational tool, assessment tool and in research is questionable. PACER is one of the free step counters application. Even though it is one of the best rated free application by users, it has never been tested for reliability and validity. Prior any use of PACER, this remains to be investigated. The objective of this work is to investigate the reliability and validity of the smartphone application PACER in measuring the number of steps and in assessing the cardiorespiratory fitness by the 6 minutes walking test. 20 overweight or obese students (10 male and 10 female) were recruited at the United Arab Emirate University, aged between 18 and 25 years old. Reliability and validity were tested in real life conditions and in controlled conditions by using a treadmill. Test-retest experiments were done with PACER on 2 days separated by a week in real life conditions (24 hours each time) and in controlled conditions (30 minutes on treadmill, 3km/h). Validity was tested against the pedometer OMRON in the same conditions. During treadmill test, video was recorded and steps numbers were compared between PACER, pedometer and video. The validity of PACER in estimating the cardiorespiratory fitness (VO2max) as part of the 6 minutes walking test (6MWT) was studied against the 20m shuttle running test. Reliability was studied by calculating intraclass correlation coefficients (ICC), 95% confidence interval (95%CI) and by Bland-Altman plots. Validity was studied by calculating Spearman correlation coefficient (rho) and Bland-Altman plots. PACER reliability was good in both male and female in real life conditions (p≤10-3) but only in female in controlled conditions (p=0.01). PACER was valid against OMRON pedometer in male and female in real life conditions (rho=0.94, p≤10-3 ; rho=0.64, p=0.01, in male and female respectively). In controlled conditions, PACER was not valid against pedometer. But, PACER was valid against video in female (rho=0.72, p≤10-3). PACER was valid against the shuttle run test in male and female (rho-=0.66, p=0.01 ; rho=0.51, p=0.04) to estimate VO2max. This study provides data on the reliability and viability of PACER in overweight or obese male and female young adults. Globally, PACER was shown as reliable and valid in real life conditions in overweight or obese male and female to count steps and assess fitness. This supports the use of PACER to assess and promote physical activity in clinical follow-up and community interventions.

Keywords: smartphone application, pacer, reliability, validity, steps, fitness, physical activity

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Authors: Oluwatobi Emmanuel Olaniyi, Babafemi George Ogunjemite

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The high rate of infrastructural development in Ikogosi warm spring towards harnessing her great ecotourism potentials calls for a serious concern, as more forest areas are been opened up for public access and the landscape is modified. On this note, we investigated the implication of ecotourism development on the floristic composition and forest structure in Ikogosi. The study aimed at identifying the past and present status of infrastructural development, assessing and comparing the floristic composition and structure of the built- up/ recreational areas and undisturbed forested areas, to infer on the impact of ecotourism development on the study site. We conducted stakeholder interview and field observation to identify the past and present status of infrastructural development respectively. A total of ten quadrants were employed in the vegetation assessment to characterize the woody tree species composition, diameter at breast height and height, to obtain mean indices characterizing each part of the site. These indices were compared using T – test analysis. A total of 49 different woody tree species distributed in 21 families were identified in the built-in/ recreational areas while 67 different woody tree species belonging to 25 families were recorded in the undeveloped forested areas. Although, the latter has a higher mean diameter at breast height of woody trees, it was not significantly different from the former (T-test = -0.74, p = 0.46). On the contrary, the built-up area had a higher mean trees height than the undeveloped areas, but the difference was not statistically significant (T-test= 1.04, p = 0.30). Despite these, the slight reduction in richness and diversity of the woody tree species in the built- up/ recreational areas implies mitigating the negative effects of infrastructural development on the warm spring's vegetation.

Keywords: ecosystem services, forest structure, vegetation assessment, warm-spring

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Authors: Ivan Sosa Gomez

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Digitalization has impacted the entire insurance value chain, and the growing movement towards P2P platforms and the collaborative economy is also beginning to have a significant impact. P2P insurance is defined as innovation, enabling policyholders to pool their capital, self-organize, and self-manage their own insurance. In this context, new InsurTech start-ups are emerging as peer-to-peer (P2P) providers, based on a model that differs from traditional insurance. As a result, although P2P platforms do not change the fundamental basis of insurance, they do enable potentially more efficient business models to be established in terms of ensuring the coverage of risk. It is therefore relevant to determine whether p2p innovation can have substantial effects on the future of the insurance sector. For this purpose, it is considered necessary to develop P2P innovation from a business perspective, as well as to build a comparison between a traditional model and a P2P model from an actuarial perspective. Objectives: The objectives are (1) to represent P2P innovation in the business model compared to the traditional insurance model and (2) to establish a comparison between a traditional model and a P2P model from an actuarial perspective. Methodology: The research design is defined as action research in terms of understanding and solving the problems of a collectivity linked to an environment, applying theory and best practices according to the approach. For this purpose, the study is carried out through the participatory variant, which involves the collaboration of the participants, given that in this design, participants are considered experts. For this purpose, prolonged immersion in the field is carried out as the main instrument for data collection. Finally, an actuarial model is developed relating to the calculation of premiums that allows for the establishment of projections of future scenarios and the generation of conclusions between the two models. Main Contributions: From an actuarial and business perspective, we aim to contribute by developing a comparison of the two models in the coverage of risk in order to determine whether P2P innovation can have substantial effects on the future of the insurance sector.

Keywords: Insurtech, innovation, business model, P2P, insurance

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Authors: Alessandro Balbo, Gianvito Colucci, Matteo Nicoli, Laura Savoldi

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Hydrogen is expected to become an undisputed player in the ecological transition throughout the next decades. The decarbonization potential offered by this energy vector provides various opportunities for the so-called “hard-to-abate” sectors, including industrial production of iron and steel, glass, refineries and the heavy-duty transport. In this regard, Italy, in the framework of decarbonization plans for the whole European Union, has been considering a wider use of hydrogen to provide an alternative to fossil fuels in hard-to-abate sectors. This work aims to assess and compare different options concerning the pathway to be followed in the development of the future Italian energy system in order to meet decarbonization targets as established by the Paris Agreement and by the European Green Deal, and to infer a techno-economic analysis of the required asset alternatives to be used in that perspective. To accomplish this objective, the Energy System Optimization Model TEMOA-Italy is used, based on the open-source platform TEMOA and developed at PoliTo as a tool to be used for technology assessment and energy scenario analysis. The adopted assessment strategy includes two different scenarios to be compared with a business-as-usual one, which considers the application of current policies in a time horizon up to 2050. The studied scenarios are based on the up-to-date hydrogen-related targets and planned investments included in the National Hydrogen Strategy and in the Italian National Recovery and Resilience Plan, with the purpose of providing a critical assessment of what they propose. One scenario imposes decarbonization objectives for the years 2030, 2040 and 2050, without any other specific target. The second one (inspired to the national objectives on the development of the sector) promotes the deployment of the hydrogen value-chain. These scenarios provide feedback about the applications hydrogen could have in the Italian energy system, including transport, industry and synfuels production. Furthermore, the decarbonization scenario where hydrogen production is not imposed, will make use of this energy vector as well, showing the necessity of its exploitation in order to meet pledged targets by 2050. The distance of the planned policies from the optimal conditions for the achievement of Italian objectives is be clarified, revealing possible improvements of various steps of the decarbonization pathway, which seems to have as a fundamental element Carbon Capture and Utilization technologies for its accomplishment. In line with the European Commission open science guidelines, the transparency and the robustness of the presented results is ensured by the adoption of the open-source open-data model such as the TEMOA-Italy.

Keywords: decarbonization, energy system optimization models, hydrogen, open-source modeling, TEMOA

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Authors: Rumesh Liyanage, S. B. Nawaratne, K. K. D. S. Ranaweera, Indira Wickramasinghe, K. G. S. C. Katukurunda

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Study it was attempted to identify an effect of food habits and publics’ attitudes on micro-sleepiness and preventive measures to develop a food product to combat. Statistical data pertaining to road accidents were collected from, Sri Lanka Police Traffic Division and a pre-tested questionnaire was used to collect data from 250 respondents. They were selected representing drivers (especially highway drivers), private and public sector workers (shift based) and cramming students (university and school). Questionnaires were directed to fill independently and personally and collected data were analyzed statistically. Results revealed that 76.84, 96.39 and 80.93% out of total respondents consumed rice for all three meals which lead to ingesting higher glycemic meals. Taking two hyper glycemic meals before 14.00h was identified as a cause of micro-sleepiness within these respondents. Peak level of road accidents were observed at 14.00 - 20.00h (38.2%)and intensity of micro-sleepiness falls at the same time period (37.36%) while 14.00 to 16.00h was the peak time, 16.00 to 18.00h was the least; again 18.00 to 20.00h it reappears slightly. Even though respondents of the survey expressed that peak hours of micro- sleepiness is 14.00-16.00h, according to police reports, peak hours fall in between 18.00-20.00h. Out of the interviewees, 69.27% strongly wanted to avoid micro-sleepiness and intend to spend LKR 10-20 on a commercial product to combat micro sleepiness. As age-old practices to suppress micro-sleepiness are time taken, modern day respondents (51.64%) like to have a quick solution through a drink. Therefore, food habits of morning and noon may cause for micro- sleepiness while dinner may cause for both, natural and micro-sleepiness due to the heavy glycemic load of food. According to the study micro-sleepiness, can be categorized into three zones such as low-risk zone (08.00-10.00h and 18.00-20.00h), manageable zone (10.00-12.00h), and high- risk zone (14.00-16.00h).

Keywords: food habits, glycemic load, micro-sleepiness, road accidents

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Authors: Mosab kh. A. A. Bashir, E. Mohamed-Ahmed

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The aim of the study is to compare the results of the external exposure and the range of the dose spread by the patients, hospitalized in two different groups of 3-5 d receiving radioiodine therapy because of thyroid cancer, and one of group were giving the local diuretic plant (barley) as local juice. The control group was 28 patients they were isolated as international precautions after taken I-131 capsule 100 mCi, and their external exposure was recorded day by day after first 24 hrs. and the distance for external measurement was 1 m at the abdominal level. The mean of external exposure values of patients at fourth day were 30.24±12.92 µSv h−1. The second group after taking I-131 capsule 100 mCi we were given barley juice (250 mL) after every meal three times on day and their external exposure was recorded day by day after first 24 hrs. The mean of external exposure values of patients of this group at third day was 26.92±9.89 (14-55) µSv h−1. It was observed that the external exposure from the second group clearly decreased to low levels which contributed to the decrease in patient dose and also to the decrease in the exposure from the patient to his/her family.

Keywords: local diuretic juice, therapy, radiation medicine, diuretic plant

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Authors: T. Radu, R. Sreenivas, H. Albuflasa, A. Mustafa Khan, W. Aloqab

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The Kingdom of Bahrain, a small island country in the Gulf region, is experiencing fast economic growth resulting in a sharp increase in population and greater than ever amounts of waste being produced. However, waste management in the country is still very basic, with landfilling being the most popular option. Recycling is still a scarce practice, with small recycling businesses and initiatives emerging in recent years. This scenario is typical for other countries in the region, with similar amounts of per capita waste being produced. In this paper, we are reviewing current waste management practices in Bahrain by collecting data published by the Government and various authors, and by visiting the country’s only landfill site, Askar. In addition, we have performed a survey of the residents to learn more about the awareness and attitudes towards sustainable waste management strategies. A review of the available data on waste management indicates that the Askar landfill site is nearing its capacity. The site uses open tipping as the method of disposal. The highest percentage of disposed waste comes from the building sector (38.4%), followed by domestic (27.5%) and commercial waste (17.9%). Disposal monitoring and recording are often based on estimates of weight and without proper characterization/classification of received waste. Besides, there is a need for assessment of the environmental impact of the site with systematic monitoring of pollutants in the area and their potential spreading to the surrounding land, groundwater, and air. The results of the survey indicate low awareness of what happens with the collected waste in the country. However, the respondents have shown support for future waste reduction and recycling initiatives. This implies that the education of local communities would be very beneficial for such governmental initiatives, securing greater participation. Raising awareness of issues surrounding recycling and waste management and systematic effort to divert waste from landfills are the first steps towards securing sustainable waste management in the Kingdom of Bahrain.

Keywords: landfill, municipal solid waste, survey, waste management

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Authors: Antonio Pizzarello, Oris Friesen

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Networks, such as the electric power grid, must demonstrate exemplary performance and integrity. Integrity depends on the quality of both the system design model and the deployed software. Integrity of the deployed software is key, for both the original versions and the many that occur throughout numerous maintenance activity. Current software engineering technology and practice do not produce adequate integrity. Distributed systems utilize networks where each node is an independent computer system. The connections between them is realized via a network that is normally redundantly connected to guarantee the presence of a path between two nodes in the case of failure of some branch. Furthermore, at each node, there is software which may fail. Self-stabilizing protocols are usually present that recognize failure in the network and perform a repair action that will bring the node back to a correct state. These protocols first introduced by E. W. Dijkstra are currently present in almost all Ethernets. Super stabilization protocols capable of reacting to a change in the network topology due to the removal or addition of a branch in the network are less common but are theoretically defined and available. This paper describes how to use the Software Integrity Assessment (SIA) methodology to analyze self-stabilizing software. SIA is based on the UNITY formalism for parallel and distributed programming, which allows the analysis of code for verifying the progress property p leads-to q that describes the progress of all computations starting in a state satisfying p to a state satisfying q via the execution of one or more system modules. As opposed to demonstrably inadequate test and evaluation methods SIA allows the analysis and verification of any network self-stabilizing software as well as any other software that is designed to recover from failure without external intervention of maintenance personnel. The model to be analyzed is obtained by automatic translation of the system code to a transition system that is based on the use of the weakest precondition.

Keywords: network, power grid, self-stabilization, software integrity assessment, UNITY, weakest precondition

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Authors: Yu Chen, Seong-Jin Kim, Jaehoon Chung

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High throughput cells counting and sizing are often required for biomedical applications. Here we report design, fabrication and validating of a micro-machined Coulter counter device with multiple-channel to realize such application for low cost. Multiple vertical through-holes were fabricated on a silicon chip, combined with the PDMS micro-fluidics channel that serves as the sensing channel. In order to avoid the crosstalk introduced by the electrical connection, instead of measuring the current passing through, the potential of each channel is monitored, thus the high throughput is possible. A peak of the output potential can be captured when the cell/particle is passing through the microhole. The device was validated by counting and sizing the polystyrene beads with diameter of 6 μm, 10 μm and 15 μm. With the sampling frequency to be set at 100 kHz, up to 5000 counts/sec for each channel can be realized. The counting and enumeration of MCF7 cancer cells are also demonstrated.

Keywords: Coulter counter, cell enumeration, high through-put, cell sizing

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Authors: Degineh Belachew Andarge, Tariku Lambiyo Anticho, Getamesay Mulatu Jara, Musa Mohammed Ali

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Introduction: Tuberculosis (TB) is a communicable chronic disease causedby Mycobacterium tuberculosis (MTB). About one-third of the world’s population is latently infected with MTB. TB is among the top 10 causes of mortality throughout the globe from a single pathogen. Objective: The aim of this study was to determine the prevalence of tuberculosis,rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosis, and associated factors among presumptive tuberculosis cases attending the tuberculosis clinic of Adare General Hospital located in Hawassa city. Methods: A hospital-based cross-sectional study was conducted among 321 tuberculosis suspected patients from April toJuly 2018. Socio-demographic, environmental, and behavioral data were collected using a structured questionnaire. Sputumspecimens were analyzed using GeneXpert. Data entry was made using Epi info version 7 and analyzed by SPSS version 20. Logistic regression models were used to determine the risk factors. A p-value less than 0.05 was taken as a cut point. Results: In this study, the prevalence of Mycobacterium tuberculosis was 98 (30.5%) with 95% confidence interval (25.5–35.8), and the prevalence of rifampicin-resistant/multidrug-resistantMycobacterium tuberculosis among the 98 Mycobacteriumtuberculosis confirmed cases was 4 (4.1%). The prevalence of rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosisamong the tuberculosis suspected patients was 1.24%. Participants who had a history of treatment with anti-tuberculosisdrugs were more likely to develop rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosis. Conclusions: This study identified relatively high rifampicin-resistant/multidrug-resistant Mycobacterium tuberculosis amongtuberculosis suspected patients in the study area. Early detection of drug-resistant Mycobacterium tuberculosis should be givenenough attention to strengthen the management of tuberculosis cases and improve direct observation therapy short-course and eventually minimize the spread of rifampicin-resistant tuberculosis strain in the community.

Keywords: rifampicin resistance, mycobacterium tuberculosis, risk factors, prevalence of TB

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Authors: Ilija Kelepurovski, Stefan Lazorovski, Pece Petkovski, Marian Anakievski, Svetlana Petkovska

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Introduction: Benign prostatic hyperplasia (BPH) is a common condition that affects men over the age of 50 and is characterized by an enlarged prostate gland that can cause lower urinary tract symptoms (LUTS). Uroflowmetry and cystoscopy are two commonly used diagnostic tests to evaluate LUTS and diagnose BPH. While both tests can be useful, there is a risk of overusing cystoscopy and underusing uroflowmetry in the evaluation of LUTS. The aim of this study was to compare the use of uroflowmetry and cystoscopy in a prospective cohort of 100 patients with suspected BPH or other urinary tract conditions and to assess the diagnostic yield of each test. Materials and Methods: This was a prospective study of 100 male patients over the age of 50 with suspected BPH or other urinary tract conditions who underwent uroflowmetry and cystoscopy for the evaluation of LUTS at a single tertiary care center. Inclusion criteria included male patients over the age of 50 with suspected BPH or other urinary tract conditions, while exclusion criteria included previous urethral or bladder surgery, active urinary tract infection, and significant comorbidities. The primary outcome of the study was the frequency of cystoscopy in the evaluation of LUTS, and the secondary outcome was the diagnostic yield of each test. Results: Of the 100 patients included in the study, 86 (86%) were diagnosed with BPH and 14 (14%) had other urinary tract conditions. The mean age of the study population was 67 years. Uroflowmetry was performed on all 100 patients, while cystoscopy was performed on 70 (70%) of the patients. The diagnostic yield of uroflowmetry was high, with a clear diagnosis made in 92 (92%) of the patients. The diagnostic yield of cystoscopy was also high, with a clear diagnosis made in 63 (90%) of the patients who underwent the procedure. There was no statistically significant difference in the diagnostic yield of uroflowmetry and cystoscopy (p = 0.20). Discussion: Our study found that uroflowmetry is an effective and well-tolerated diagnostic tool for evaluating LUTS and diagnosing BPH, with a high diagnostic yield and low risk of complications. Cystoscopy is also a useful diagnostic tool, but it is more invasive and carries a small risk of complications such as bleeding or urinary tract infection. Both tests had a high diagnostic yield, suggesting that either test can provide useful information in the evaluation of LUTS. However, the fact that 70% of the study population underwent cystoscopy raises concerns about the potential overuse of this test in the evaluation of LUTS. This is especially relevant given the focus on patient-centered care and the need to minimize unnecessary or invasive procedures. Our findings underscore the importance of considering the clinical context and using evidence-based guidelines. Conclusion: In this prospective study of 100 patients with suspected BPH or other urinary tract conditions, we found that uroflowmetry and cystoscopy were both valuable diagnostic tools for the evaluation of LUTS. However, the potential overuse of cystoscopy in this population warrants further investigation and highlights the need for careful consideration of the optimal use of diagnostic tests in the evaluation of LUTS and the diagnosis of BPH. Further research is needed to better understand the relative roles of uroflowmetry and cystoscopy in the diagnostic workup of patients with LUTS, and to develop evidence-based guidelines for their appropriate use.

Keywords: uroflowmetry, cystoscopy, LUTS, BPH

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Authors: Sireen Irsheid

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Despite concerted efforts to improve education attainment with progress in recent years, student achievement and attainment remain among the most significant challenges for school districts across the United States. Many scholars have argued that students who do not complete high school do not drop out of school voluntarily but are ‘pushed out’ of schools through multiple mechanisms related to structural and socioeconomic barriers, behavioral health challenges, pedagogical practices, and administrative procedures. Extant literature has shown that living in historically disadvantaged neighborhoods or attending under-resourced schools exacerbates student-level risk factors for grade retention and school pushout. Most efforts to respond to the school pushout phenomenon have focused on individual characteristics of students, with relatively little attention to addressing these multiple system-level characteristics related to perpetuating inequities. This study is built on a growing body of social justice-oriented research concerned with the systemic influences that shape the experiences and mental health challenges of young people. Specifically, this study examined how young people who have been experiencing education inequities make meaning and navigate the structural factors related to neighborhood and school disinvestment and access to resources and supports, and their risk for school pushout. Furthermore, schools as political, cultural, and ideologically reproductive spaces often serve as sites of resistance and can support students who are impacted by educational inequity. Study findings provide education, neighborhood, school psychology, social work practice, and policy considerations.

Keywords: education policy, mental health, school prison nexus, school pushout, structural trauma

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Authors: Halima Sadia Qureshi, Urooj Sadiq, Noshi Eram Zaman

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The goal of this study was to see how cognitive behavior hypnotherapy affected nonsuicidal self-injury. DSM 5 invites the researchers to explore the newly added condition under the chapter of conditions under further study named Nonsuicidal self-injury disorder. To date, no empirical sound intervention has been proven effective for NSSI as given in DSM 5. Nonsuicidal self-injury is defined by DSM 5 as harming one's self physically, without suicidal intention. Around 7.6% of teenagers are expected to fulfill the NSSI disorder criteria. 3 Adolescents, particularly university students, account for around 87 percent of self-harm studies. Furthermore, one of the risks associated with NSSI is an increased chance of suicide attempts, and in most cases, the cycle repeats again. 6 The emotional and psychological components of the illness might lead to suicide, either intentionally or unintentionally. 7 According to a research done at a Pakistani military hospital, over 80% of participants had no intention of committing suicide. Furthermore, it has been determined that improvements in NSSI prevention and intervention are necessary as a stand-alone strategy. The quasi-experimental study took place in Islamabad and Rawalpindi, Pakistan, from May 2019 to April 2020 and included students aged 18 to 25 years old from several institutions and colleges in the twin cities. According to the Diagnostic and Statistical Manual of Mental Disorders 5th edition, the individuals were assessed for >2 episodes without suicidal intent using the intentional self-harm questionnaire. The Clinician Administered Nonsuicidal Self-Injury Disorder Index (CANDI) was used to assess the individual for NSSI condition. Symptom checklist-90 (SCL-90) was used to screen the participants for differential diagnosis. Mclean Screening Instrument for Borderline Personality Disorder (MSI-BPD) was used to rule out the BPD cases. The selected participants, n=106 from the screening sample of 600, were selected. They were further screened to meet the inclusion and exclusion criteria, and the total of n=71 were split into two groups: intervention and control. The intervention group received cognitive behavior hypnotherapy for the next three months, whereas the control group received no treatment. After the period of three months, both the groups went through the post assessment, and after the three months’ period, follow-up assessment was conducted. The groups were evaluated, and SPSS 25 was used to analyse the data. The results showed that each of the two groups had 30 (50 percent) of the 60 participants. There were 41 males (68 percent) and 19 girls (32 percent) in all. The bulk of the participants were between the ages of 21 and 23. (48 percent). Self-harm events were reported by 48 (80 percent) of the pupils, and suicide ideation was found in 6 (ten percent). In terms of pre- and post-intervention values (d=4.90), post-intervention and follow-up assessment values (d=0.32), and pre-intervention and follow-up values (d=5.42), the study's effect size was good. The comparison of treatment and no-treatment groups revealed that treatment was more successful than no-treatment, F (1, 58) = 53.16, p.001. The results reveal that the treatment manual of CBH is effective for Nonsuicidal self-injury disorder.

Keywords: NSSI, nonsuicidal self injury disorder, self-harm, self-injury, Cognitive behaviour hypnotherapy, CBH

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Authors: Ena Arora, Rong Fan, Aleksandr Fuks, Kolawole Felix Akinnawonu

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Introduction: Leiomyomas are benign tumors that are derived from the overgrowth of uterine smooth muscle cells. Women with symptomatic leiomyomas who desire future fertility, myomectomy should be the standard surgical treatment. Perioperative hemorrhage is a common complication in myomectomy. We performed the study to investigate blood transfusion rate in abdominal myomectomies, risk factors influencing blood loss and modalities to improve perioperative blood loss. Methods: Retrospective chart review was done for patients who underwent myomectomy from 2016 to 2022 at Queens hospital center, New York. We looked at preoperative patient demographics, clinical characteristics, intraoperative variables, and postoperative outcomes. Mann-Whitney U test were used for parametric and non-parametric continuous variable comparisons, respectively. Results: A total of 159 myomectomies were performed between 2016 and 2022, including 1 laparoscopic, 65 vaginal and 93 abdominal. 44 patients received blood transfusion during or within 72 hours of abdominal myomectomy. The blood transfusion rate was 47.3%. Blood transfusion rate was found to be twice higher than the average documented rate in literature which is 20%. Risk factors identified were black race, preoperative hematocrit<30%, preoperative blood transfusion within 72 hours, large fibroid burden, prolonged surgical time, and abdominal approach. Conclusion: Preoperative optimization with iron supplements or GnRH agonists is important for patients undergoing myomectomy. Interventions to decrease intra operative blood loss should include cell saver, tourniquet, vasopressin, misoprostol, tranexamic acid and gelatin-thrombin matrix hemostatic sealant.

Keywords: myomectomy, perioperative blood loss, cell saver, tranexamic acid

Procedia PDF Downloads 80