Search results for: chest CT imagery

Authors: Justine A. Lloyd

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Since the onset of the Syrian Civil War in 2011, the ancient city of Dura-Europos has faced widespread destruction and looting. The site is one of many places in the country the terrorist group ISIS has specifically targeted, allegedly due to its particular representations of Syrian history and culture. However, looted art and artifacts are the extremist group’s second largest source of income, only after oil. The protection of this site is important to both academics and the millions who have called Syria a home, as it aids in the nation’s sense of identity, reveals developments in the arts, and contributes to humanity’s collective history. At a time when Syria’s culture is being flattened, this sense of cultural expression is especially important to maintain. Creating an awareness of the magnitude of the issue at hand begins with an examination of the rich history of the ancient fortress city. Located on the western bank of the Euphrates River, Dura-Europos contains artifacts dating back to the Hellenistic, Parthian, and Roman periods. Though a great deal of the art and artifacts have remained safe in institutions such as the National Museum of Damascus and the Yale University Art Gallery, hundreds of looting pits and use of heavy machinery on the site has severely set back the investigative progress made by archaeologists over the last century, as well as the prospect of future excavation. Further research draws on the current destruction of the site by both ISIS and opportunists involved with the black market. Because Dura-Europos is located in a war stricken region, the acquisition of data and possibility of immediate action is particularly challenging. Resources gained from local reports, in addition to technology such as satellite imagery, however, have provided a firm starting point for the evaluation of the state of the site. The Syrian Ministry of Culture, UNESCO, and numerous Syrian and global organizations provide insight into the historic city’s past, present issues, and future plans to ensure that the cultural integrity of the site is upheld. Though over seventy percent of Dura-Europos has been completely decimated, this research challenges the notion that physically destroyed sites are lost forever. This paper assesses preventative measures that can take place to ensure the preservation of the site’s art and architecture, including examining possible solutions to the damage, such as digital reconstruction, replication, and distribution of information through exhibitions and other forms of publically accessible information. In order to investigate any possible retribution, research also includes the necessary information pertaining the global laws and regulations dealing with cultural heritage, as it directly affects the ways in which this situation can be dealt with. With the countless experts and citizens dedicated to the importance of cultural heritage, the prospect of honoring and valuing elements of Dura-Europos is possible—whether physically preserved or otherwise.

Keywords: antiquities law, archaeological sites, restitution, Syrian Civil War

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Authors: Bensaid A., Mostephaoui T., Nedjai R.

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A considerable area of Algerian lands are threatened by the phenomenon of wind erosion. For a long time, wind erosion and its associated harmful effects on the natural environment have posed a serious threat, especially in the arid regions of the country. In recent years, as a result of increases in the irrational exploitation of natural resources (fodder) and extensive land clearing, wind erosion has particularly accentuated. The extent of degradation in the arid region of the Algerian Mécheriadepartment generated a new situation characterized by the reduction of vegetation cover, the decrease of land productivity, as well as sand encroachment on urban development zones. In this study, we attempt to investigate the potential of remote sensing and geographic information systems for detecting the spatial dynamics of the ancient dune cords based on the numerical processing of PlanetScope PSB.SB sensors images by September 29, 2021. As a second step, we prospect the use of a multi-scale geographic object-based image analysis (GEOBIA) approach to segment the high spatial resolution images acquired on heterogeneous surfaces that vary according to human influence on the environment. We have used the fractal net evolution approach (FNEA) algorithm to segment images (Baatz&Schäpe, 2000). Multispectral data, a digital terrain model layer, ground truth data, a normalized difference vegetation index (NDVI) layer, and a first-order texture (entropy) layer were used to segment the multispectral images at three segmentation scales, with an emphasis on accurately delineating the boundaries and components of the sand accumulation areas (Dune, dunes fields, nebka, and barkhane). It is important to note that each auxiliary data contributed to improve the segmentation at different scales. The silted areas were classified using a nearest neighbor approach over the Naâma area using imagery. The classification of silted areas was successfully achieved over all study areas with an accuracy greater than 85%, although the results suggest that, overall, a higher degree of landscape heterogeneity may have a negative effect on segmentation and classification. Some areas suffered from the greatest over-segmentation and lowest mapping accuracy (Kappa: 0.79), which was partially attributed to confounding a greater proportion of mixed siltation classes from both sandy areas and bare ground patches. This research has demonstrated a technique based on very high-resolution images for mapping sanded and degraded areas using GEOBIA, which can be applied to the study of other lands in the steppe areas of the northern countries of the African continent.

Keywords: land development, GIS, sand dunes, segmentation, remote sensing

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Authors: Mokhlisur Rahman

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Ocean inhibits one of the most complex ecosystems on the planet that regulates the earth's climate and weather by providing us with compatible weather to live. Ocean provides food by extending various ways of lifestyles that are dependent on it, transportation by accommodating the world's biggest carriers, recreation by offering its beauty in many moods, and home to countless species. At the essence of receiving various forms of entertainment, consumers choose to be close to the ocean while performing many fun activities. Which, at some point, upsets the stomach of the ocean by threatening marine life and the environment. Consumers throw the waste into the ocean after using it. Most of them are plastics that float over the ocean and turn into thousands of micro pieces that are hard to observe with the naked eye but easily eaten by the sea species. Eventually, that conflicts with the natural consumption process of any living species, making them sick. This information is not known by most consumers who go to the sea or seashores occasionally to spend time, nor is it widely discussed, which creates an information gap among consumers. However, advertising is a powerful tool to educate people about ocean pollution. This abstract analyzes three major ocean-saving advertisement campaigns that use innovative and advanced technology to get maximum exposure. The study collects data from the selected campaigns' websites and retrieves all available content related to messages, videos, and images. First, the SeaLegacy campaign uses stunning images to create awareness among the people; they use social media content, videos, and other educational content. They create content and strategies to build an emotional connection among the consumers that encourage them to move on an action. All the messages in their campaign empower consumers by using powerful words. Second, Ocean Conservancy Campaign uses social media marketing, events, and educational content to protect the ocean from various pollutants, including plastics, climate change, and overfishing. They use powerful images and videos of marine life. Their mission is to create evidence-based solutions toward a healthy ocean. Their message includes the message regarding the local communities along with the sea species. Third, ocean clean-up is a campaign that applies strategies using innovative technologies to remove plastic waste from the ocean. They use social media, digital, and email marketing to reach people and raise awareness. They also use images and videos to evoke an emotional response to take action. These tree advertisements use realistic images, powerful words, and the presence of living species in the imagery presentation, which are eye-catching and can grow emotional connection among the consumers. Identifying the effectiveness of the messages these advertisements carry and their strategies highlights the knowledge gap of mass people between real pollution and its consequences, making the message more accessible to the mass of people. This study aims to provide insights into the effectiveness of ocean-saving advertisement campaigns and their impact on the public's awareness of ocean conservation. The findings from this study help shape future campaigns.

Keywords: advertising-campaign, content-creation, images ocean-saving technology, videos

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Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

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Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

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Authors: Nadia K. Thalji

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In the timeless tapestry of human culture, theater, mythology, and psychology intersect to weave narratives that transcend temporal and spatial boundaries. For millennia, actors have stood as guardians of intuitive wisdom, their craft serving as a conduit for the collective unconscious. This paper embarks on a journey through the realms of creative expression, melding the insights of cross-cultural psychology with the mystical allure of serendipity and synchronicity. At the nexus of these disciplines lies the enigmatic process of active imagination, a gateway to the depths of the psyche elucidated by Jung. Within the hallowed confines of the black box theater at the Department of Performing Arts, UFRGS University in Brazil, this study unfolds. Over the span of four months, a cadre of artists embarked on a voyage of exploration, harnessing the powers of imagery, movement, sound, and dreams to birth a performance that resonated with the echoes of ancient wisdom. Drawing inspiration from the fabled Oracle of Delphi and the priestesses who once dwelled within its sacred precincts, the production delves into the liminal spaces where myth and history intertwine. Through the alchemy of storytelling, participants navigate the labyrinthine corridors of cultural memory, unraveling the threads that bind the past to the present. Central to this endeavor is the phenomenon of synchronicity, wherein seemingly disparate elements coalesce in a dance of cosmic resonance. Serendipity becomes a guiding force, leading actors and audience alike along unexpected pathways of discovery. As the boundaries between performer and spectator blur, the performance becomes a crucible wherein individual narratives merge to form a collective tapestry of shared experience. Yet, beneath the surface of spectacle lies a deeper truth: the exploration of the spiritual dimensions of artistic expression. Through intuitive inquiry and embodied practice, artists tap into reservoirs of insight that transcend rational comprehension. In the communion of minds and bodies, the stage becomes a sacred space wherein the numinous unfolds in all its ineffable glory. In essence, this paper serves as a testament to the transformative power of the creative act. Across cultures and epochs, the theater has served as a crucible wherein humanity grapples with the mysteries of existence. Through the lens of cross-cultural psychology, we glimpse the universal truths that underlie the myriad manifestations of human creativity. As we navigate the turbulent currents of modernity, the wisdom of the ancients beckons us to heed the call of the collective unconscious. In the synthesis of myth and meaning, we find solace amidst the chaos, forging connections that transcend the boundaries of time and space. And in the sacred precincts of the theater, we discover the eternal truth that art is, and always shall be, the soul's journey into the unknown.

Keywords: theater, mythology, cross-cultural, synchronicity, creativity, serendipity, spiritual

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Authors: Karlee J. Hall, Mark Laylor, Jessy Varghese, Paula Polastri, Karen Van Ooteghem, William McIlroy

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Balance training is a common part of physiotherapy treatment and often involves a set of proprioceptive exercises which the patient carries out in the clinic and as part of their exercise program. Understanding all contributing factors to altered balance is of utmost importance to the clinical success of treatment of balance dysfunctions. A critical role for the autonomic nervous system (ANS) in the control of balance reactions has been proposed previously, with evidence for potential involvement being inferred from the observation of phasic galvanic skin responses (GSR) evoked by external balance perturbations. The current study explored whether the coupling between ANS reactivity and balance reactions would be observed during spontaneously occurring instability while standing, including standard positions typical of physiotherapy balance assessments. It was hypothesized that time-varying changes in GSR (ANS reactivity) would be associated with time-varying changes in the mediolateral center of pressure (ML-COP) (somatomotor reactivity). Nine individuals (5 females, 4 males, aged 19-37 years) were recruited. To induce varying balance demands during standing, the study compared ML-COP and GSR data across different task conditions varying the availability of vision and width of the base of support. Subjects completed 3, 30-second trials for each of the following stance conditions: standard, narrow, and tandem eyes closed, tandem eyes open, tandem eyes open with dome to shield visual input, and restricted peripheral visual field. ANS activity was evaluated by measures of GSR recorded from Ag-AgCl electrodes on the middle phalanges of digits 2 and 4 on the left hand; balance measures include ML-COP excursion frequency and amplitude recorded from two force plates embedded in the floor underneath each foot. Subjects were instructed to stand as still as possible with arms crossed in front of their chest. When comparing mean task differences across subjects, there was an expected increase in postural sway from tasks with a wide stance and no sensory restrictions (least challenging) to those with a narrow stance and no vision (most challenging). The correlation analysis revealed a significant positive relationship between ML-COP variability and GSR variability when comparing across tasks (r=0.94, df=5, p < 0.05). In addition, correlations coincided within each subject and revealed a significant positive correlation in 7 participants (r= 0.47, 0.57, 0.62, 0.62, 0.81, 0.64, 0.69 respectively, df=19, p < 0.05) and no significant relationship in 2 participants (r=0.36, 0.29 respectively, df=19, p > 0.05). The current study revealed a significant relationship between ML-COP and GSR during balance tasks, revealing the ANS reactivity associated with naturally occurring instability when standing still, which is proportional to the degree of instability. Understanding the link between ANS activity and control of COP is an important step forward in the enhancement of assessment of contributing factors to poor balance and treatment of balance dysfunctions. The next steps will explore the temporal association between the time-varying changes in COP and GSR to establish if the ANS reactivity phase leads or lags the evoked motor reactions, as well as exploration of potential biomarkers for use in screening of ANS activity as a contributing factor to altered balance control clinically.

Keywords: autonomic nervous system, balance control, center of pressure, somatic nervous system

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Authors: Jelena Maletkovic

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Background: Endogenous Cushing’s syndrome is a rare disease, but iatrogenic or drug related Cushing syndrome from glucocorticoid products is commonly seen in clinical practice. With high dose and long term use of glucocorticoids, patients can develop isolated hypothalamic-pituitary-adrenal (HPA) suppression, or HPA axis suppression can be accompanied by overt iatrogenic Cushing’s syndrome. This is a rare case where severe Cushing’s syndrome developed from an unknown medication and was followed by severe and prolonged adrenal insufficiency and multiple potentially fatal complications. Case: This is a 37-year-old woman who is presented to Emergency Room (ER) with shortness of breath and chest pain. Four months prior to this presentation the patient was a generally healthy woman who was looking for improvement in her appearance and visited local Rejuvenation Clinic. After initial consultation with a nurse, she was contacted by a physician over the phone and was advised to start taking multiple injectable medications that will arrive by mail. Medications without any labels on bottles were delivered and the patient started daily intramuscular injections. Over the next two months, she noticed rounding of her face and swelling around her eyes. She gained 20 pounds, mostly abdominal fat and became extremely fatigued. Her muscles on legs were visibly decreasing in size and she felt significant muscle weakness. Unexplained bruising occurred. She started growing hair on face and developed secondary amenorrhea. New severe back pain started. She developed depression and headaches. Finally, over a few days, a number of red-purple stretch marks that were sensitive and painful appeared over her abdomen, upper part of arms and legs. She then became suspicious that these dramatic symptoms are caused by injectable medication and she discontinued injections. Over the next few days she presented to ER with low blood pressure and oxygen saturation of 75%. Studies revealed extensive pneumonia as well as multiple pulmonary emboli. Her white blood count was elevated with 32 000 and she also had acute kidney failure on admission. She was treated for sepsis and was also given stress dose steroids. Steroids were tapered over 48 hours and discontinued. After being discharged to home, on her first visit to endocrinology clinic she had undetectable ACTH of < 2pg/mL and undetectable 8am cortisol of < 0.2mcg/dL. She did not respond to an intramuscular injection of cosyntropin 250mcg and her repeated cortisol after 60 minutes was only 1mcg/dL. The patient was diagnosed with adrenal insufficiency and was started on hydrocortisone 20mg+10mg. It took close to 2 years of slow tapering for recovery of this patient’s HPA axis and resolve all the sequelae from Cushing’s syndrome. Conclusion: Misuse and abuse of glucocorticoids have been present almost since these medications were discovered. This is a rare case where not only severe Cushing’s syndrome in full clinical picture developed but also the patient suffered multiple potentially fatal complications and prolonged adrenal insufficiency. Visits to herbal, rejuvenation, esthetic, and similar clinics are becoming more and more popular and physicians need to be aware of possible non-benign nature of medications that their patients may be using.

Keywords: iatrogenic, Cushing's syndrome, adrenal crisis, steroid abuse

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Authors: Tracy L. F. Worley

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This presentation explores the environment that has limited leadership opportunities for Black women in cinema and advocates for autonomy among Black women filmmakers that is facilitated by strong internal and external networks and cooperative opportunities. Early images of African Americans in motion pictures were often conceptualized from the viewpoint of a White male director and depicted by White actors. The black film evolved in opposition to this context, leading to a Black film aesthetic. The oppositional context created in response to racist, misogynistic, and sexist representations in motion pictures sets the tone for female filmmakers of every hue – but especially for African American women. For them, the context of a male gaze, and for all intents and purposes, a White male gaze, forces them to create their own aesthetic. Theoretically, men and women, filmmakers and spectators have different perspectives across race, ethnicity, and gender. Two feminist theorists, bell hooks and Mary Ann Doane, suggest that female filmmakers are perceived as disparate from male filmmakers and that women, in general, are defined by what men see. Mary Ann Doane, a White feminist film theorist, has focused extensively on female spectatorship and women (White) in general as the object of the male gaze. Her discussion of the female body, male perception of it, and feminism in the motion picture industry support the suggestion that comprehending the organization and composition of Hollywood is critical to understanding women’s roles in the industry. Although much of her research addresses the silent film era and women’s roles then, Doane suggests that across cinematic periods, the theory assigned to “cinematic apparatus” is formulated within a context of sexuality. Men and women are viewed and treated differently in cinema (in front of and behind the camera), with women’s attractiveness and allure photographed specifically for the benefit of the “spectatorial desire” of the male gaze. Bell Hooks, an African American feminist writer and theorist with more than 30 published books and articles on race, gender, class, and culture in feminism and education, suggests that women can overcome the male gaze by using their “oppositional gaze” to transform reality and establish their own truth. She addresses gender within the context of race by acknowledging the realities faced by African American women and the fact that the feminist movement was never intended to include Black women. A grounded theory study led to the development of a leadership theory that explains why African American women are disproportionately represented in a mainstream motion picture leadership. The study helped to reveal the barriers to entry and illuminated potential strategies that African American female motion picture directors might pursue to reduce this inequity. Using semi-structured interviews as the primary means for data collection, the lived experiences of African American female directors and organizational leadership’s perceived role in the perpetuation of negative female imagery in major motion pictures led to the identification of support strategies for African American female motion picture directors that counter social stereotyping and validate the need for social networking in the mainstream.

Keywords: African American, cinema, directors, filmmaking, leadership, women

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Authors: Grace E. Santella, Shawn G. Gallaher, Joseph P. Smith

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In order to determine the importance of small-system riverine heat flux on regional landfast sea ice breakup, our study explores the annual spring freshet of the Sagavanirktok River from 2014-2019. Seasonal heat cycling ultimately serves as the driving mechanism behind the freshet; however, as an emerging area of study, the extent to which inland thermodynamics influence coastal tundra geomorphology and connected landfast sea ice has not been extensively investigated in relation to small-scale Arctic river systems. The Sagavanirktok River is a small-to-midsized river system that flows south-to-north on the Alaskan North Slope from the Brooks mountain range to the Beaufort Sea at Prudhoe Bay. Seasonal warming in the spring rapidly melts snow and ice in a northwards progression from the Brooks Range and transitional tundra highlands towards the coast and when coupled with seasonal precipitation, results in a pulsed freshet that propagates through the Sagavanirktok River. The concentrated presence of newly exposed vegetation in the transitional tundra region due to spring melting results in higher absorption of solar radiation due to a lower albedo relative to snow-covered tundra and/or landfast sea ice. This results in spring flood runoff that advances over impermeable early-season permafrost soils with elevated temperatures relative to landfast sea ice and sub-ice flow. We examine the extent to which interannual temporal variability influences the onset and magnitude of river discharge by analyzing field measurements from the United States Geological Survey (USGS) river and meteorological observation sites. Rapid influx of heat to the Arctic Ocean via riverine systems results in a noticeable decay of landfast sea ice independent of ice breakup seaward of the shear zone. Utilizing MODIS imagery from NASA’s Terra satellite, interannual variability of river discharge is visualized, allowing for optical validation that the discharge flow is interacting with landfast sea ice. Thermal erosion experienced by sediment fast ice at the arrival of warm overflow preconditions the ice regime for rapid thawing. We investigate the extent to which interannual heat flux from the Sagavanirktok River’s freshet significantly influences the onset of local landfast sea ice breakup. The early-season warming of atmospheric temperatures is evidenced by the presence of storms which introduce liquid, rather than frozen, precipitation into the system. The resultant decreased albedo of the transitional tundra supports the positive relationship between early-season precipitation events, inland thermodynamic cycling, and degradation of landfast sea ice. Early removal of landfast sea ice increases coastal erosion in these regions and has implications for coastline geomorphology which stress industrial, ecological, and humanitarian infrastructure.

Keywords: Albedo, freshet, landfast sea ice, riverine heat flux, seasonal heat cycling

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Authors: Alberto Azevedo, Ricardo Martins, André B. Fortunato, Anabela Oliveira

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Water is under severe threat today because of the rising population, increased agricultural and industrial needs, and the intensifying effects of climate change. Due to sea-level rise, erosion, and demographic pressure, the coastal regions are of significant concern to the scientific community. The Water Monitoring Sentinel Cloud platform (WORSICA) service is focused on providing new tools for monitoring water in coastal and inland areas, taking advantage of remote sensing, in situ and tidal modeling data. WORSICA is a service that can be used to determine the coastline, coastal inundation areas, and the limits of inland water bodies using remote sensing (satellite and Unmanned Aerial Vehicles - UAVs) and in situ data (from field surveys). It applies to various purposes, from determining flooded areas (from rainfall, storms, hurricanes, or tsunamis) to detecting large water leaks in major water distribution networks. This service was built on components developed in national and European projects, integrated to provide a one-stop-shop service for remote sensing information, integrating data from the Copernicus satellite and drone/unmanned aerial vehicles, validated by existing online in-situ data. Since WORSICA is operational using the European Open Science Cloud (EOSC) computational infrastructures, the service can be accessed via a web browser and is freely available to all European public research groups without additional costs. In addition, the private sector will be able to use the service, but some usage costs may be applied, depending on the type of computational resources needed by each application/user. Although the service has three main sub-services i) coastline detection; ii) inland water detection; iii) water leak detection in irrigation networks, in the present study, an application of the service to Óbidos lagoon in Portugal is shown, where the user can monitor the evolution of the lagoon inlet and estimate the topography of the intertidal areas without any additional costs. The service has several distinct methodologies implemented based on the computations of the water indexes (e.g., NDWI, MNDWI, AWEI, and AWEIsh) retrieved from the satellite image processing. In conjunction with the tidal data obtained from the FES model, the system can estimate a coastline with the corresponding level or even topography of the inter-tidal areas based on the Flood2Topo methodology. The outcomes of the WORSICA service can be helpful for several intervention areas such as i) emergency by providing fast access to inundated areas to support emergency rescue operations; ii) support of management decisions on hydraulic infrastructures operation to minimize damage downstream; iii) climate change mitigation by minimizing water losses and reduce water mains operation costs; iv) early detection of water leakages in difficult-to-access water irrigation networks, promoting their fast repair.

Keywords: remote sensing, coastline detection, water detection, satellite data, sentinel, Copernicus, EOSC

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Authors: Agnes Simone

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A 52-year-old male with unknown psychiatric and medical history was brought to the Psychiatric Emergency Room by ambulance directly from jail. He had been detained for three weeks for possession of a firearm while intoxicated. On initial evaluation, the patient was unable to provide a reliable history. He presented with odd jerking movements of his extremities and catatonic features, including mutism and stupor. His vital signs were stable. Patient was transferred to the medical emergency department for work-up of altered mental status. Due to suspicion for opioid overdose, the patient was given naloxone (Narcan) with no improvement. Laboratory work-up included complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, vitamin B12, folate, magnesium, rapid plasma reagin, HIV, blood alcohol level, aspirin, and Tylenol blood levels, urine drug screen, and urinalysis, which were all negative. CT head and chest X-Ray were also negative. With this negative work-up, the medical team concluded there was no organic etiology and requested inpatient psychiatric admission. Upon re-evaluation by psychiatry, it was evident that the patient continued to have an altered mental status. Of note, the medical team did not include substance withdrawal in the differential diagnosis due to stable vital signs and a negative urine drug screen. The psychiatry team decided to check California's prescription drug monitoring program (CURES) and discovered that the patient was prescribed benzodiazepine alprazolam (Xanax) 2mg BID, a sedative-hypnotic, and hydrocodone/acetaminophen 10mg/325mg (Norco) QID, an opioid. After a thorough chart review, his daughter's contact information was found, and she confirmed his benzodiazepine and opioid use, with recent escalation and misuse. It was determined that the patient was experiencing alprazolam withdrawal, given this collateral information, his current symptoms, negative urine drug screen, and recent abrupt discontinuation of medications while incarcerated. After admission to the medical unit and two doses of alprazolam 2mg, the patient's mental status, alertness, and orientation improved, but he had no memory of the events that led to his hospitalization. He was discharged with a limited supply of alprazolam and a close follow-up to arrange a taper. Accompanying this case report, a qualitative review of presentations with alprazolam withdrawal was completed. This case and the review highlights: (1) Alprazolam withdrawal can occur at low doses and within just one week of use. (2) Alprazolam withdrawal can present without any vital sign instability. (3) Alprazolam withdrawal does not respond to short-acting benzodiazepines but does respond to certain long-acting benzodiazepines due to its unique chemical structure. (4) Alprazolam withdrawal is distinct from and more severe than other benzodiazepine withdrawals. This case highlights (1) the importance of physician utilization of drug-monitoring programs. This case, in particular, relied on California's drug monitoring program. (2) The importance of obtaining collateral information, especially in cases in which the patient is unable to provide a reliable history. (3) The importance of including substance intoxication and withdrawal in the differential diagnosis even when there is a negative urine drug screen. Toxidrome of withdrawal can be delayed. (4) The importance of discussing addiction and withdrawal risks of medications with patients.

Keywords: addiction risk of benzodiazepines, alprazolam withdrawal, altered mental status, benzodiazepines, drug monitoring programs, sedative-hypnotics, substance use disorder

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Authors: Ashlie Latiolais

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Architecture, as a discipline, is on a trajectory of extension beyond the boundaries of buildings and, more increasingly, is coupled with research that connects to alternative and typically disjointed disciplines. A “both/and” approach and (expanded) definition of architecture, as depicted here, expands the margins that contain the profession. Figuratively, architecture is a series of edges, events, and occurrences that establishes a choreography or stage by which humanity exists. The way in which architecture controls and suggests the movement through these spaces, being within a landscape, city, or building, can be viewed as a datum by which the “dance” of everyday life occurs. This submission views the realm of architecture through the lens of movement and dance as a cross-fertilizer of collaboration, tectonic, and spatial geometry investigations. “Designing on digital programs puts architects at a distance from the spaces they imagine. While this has obvious advantages, it also means that they lose the lived, embodied experience of feeling what is needed in space—meaning that some design ideas that work in theory ultimately fail in practice.” By studying the body in motion through real-time performance, a more holistic understanding of architectural space surfaces and new prospects for theoretical teaching pedagogies emerge. The atypical intersection rethinks how architecture is considered, created, and tested, similar to how “dance artists often do this by thinking through the body, opening pathways and possibilities that might not otherwise be accessible” –this is the essence of this poster submission as explained through unFOLDED, a creative performance work. A new languageismaterialized through unFOLDED, a dynamic occupiable installation by which architecture is investigated through dance, movement, and body analysis. The entry unfolds a collaboration of an architect, dance choreographer, musicians, video artist, and lighting designers to re-create one of the first documented avant-garde performing arts collaborations (Matisse, Satie, Massine, Picasso) from the Ballet Russes in 1917, entitled Parade. Architecturally, this interdisciplinary project orients and suggests motion through structure, tectonic, lightness, darkness, and shadow as it questions the navigation of the dark space (stage) surrounding the installation. Artificial light via theatrical lighting and video graphics brought the blank canvas to life – where the sensitive mix of musicality coordinated with the structure’s movement sequencing was certainly a challenge. The upstage light from the video projections created both flickered contextual imagery and shadowed figures. When the dancers were either upstage or downstage of the structure, both silhouetted figures and revealed bodies are experienced as dancer-controlled installation manipulations occurred throughout the performance. The experimental performance, through structure, prompted moving (dancing) bodies in space, where the architecture served as a key component to the choreography itself. The tectonic of the delicate steel structure allowed for the dancers to interact with the installation, which created a variety of spatial conditions – the contained box of three-dimensional space, to a wall, and various abstracted geometries in between. The development of this research unveils the new role of an Architect as a Choreographer of the built environment.

Keywords: dance, architecture, choreography, installation, architect, choreographer, space

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Authors: Katerina Krizova, Inigo Molina

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The ongoing climate change affects various natural processes resulting in significant changes in human life. Since there is still a growing human population on the planet with more or less limited resources, agricultural production became an issue and a satisfactory amount of food has to be reassured. To achieve this, agriculture is being studied in a very wide context. The main aim here is to increase primary production on a spatial unit while consuming as low amounts of resources as possible. In Europe, nowadays, the staple issue comes from significantly changing the spatial and temporal distribution of precipitation. Recent growing seasons have been considerably affected by long drought periods that have led to quantitative as well as qualitative yield losses. To cope with such kind of conditions, new techniques and technologies are being implemented in current practices. However, behind assessing the right management, there is always a set of the necessary information about plot properties that need to be acquired. Remotely sensed data had gained attention in recent decades since they provide spatial information about the studied surface based on its spectral behavior. A number of space platforms have been launched carrying various types of sensors. Spectral indices based on calculations with reflectance in visible and NIR bands are nowadays quite commonly used to describe the crop status. However, there is still the staple limit by this kind of data - cloudiness. Relatively frequent revisit of modern satellites cannot be fully utilized since the information is hidden under the clouds. Therefore, microwave remote sensing, which can penetrate the atmosphere, is on its rise today. The scientific literature describes the potential of radar data to estimate staple soil (roughness, moisture) and vegetation (LAI, biomass, height) properties. Although all of these are highly demanded in terms of agricultural monitoring, the crop moisture content is the utmost important parameter in terms of agricultural drought monitoring. The idea behind this study was to exploit the unique combination of SAR (Sentinel-1) and optical (Sentinel-2) data from one provider (ESA) to describe potential crop water stress during dry cropping season of 2019 at six winter wheat plots in the central Czech Republic. For the period of January to August, Sentinel-1 and Sentinel-2 images were obtained and processed. Sentinel-1 imagery carries information about C-band backscatter in two polarisations (VV, VH). Sentinel-2 was used to derive vegetation properties (LAI, FCV, NDWI, and SAVI) as support for Sentinel-1 results. For each term and plot, summary statistics were performed, including precipitation data and soil moisture content obtained through data loggers. Results were presented as summary layouts of VV and VH polarisations and related plots describing other properties. All plots performed along with the principle of the basic SAR backscatter equation. Considering the needs of practical applications, the vegetation moisture content may be assessed using SAR data to predict the drought impact on the final product quality and yields independently of cloud cover over the studied scene.

Keywords: precision agriculture, remote sensing, Sentinel-1, SAR, water content

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Authors: Elena Parmentier, Henrik Endeman

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Introduction: Large mediastinal masses often present with diagnostic and clinical challenges due to compression of the respiratory and hemodynamic system. We present a case of a mediastinal mass with symptomatic mechanical compression of the trachea, resulting in challenging airway management. Methods: We present a case of 66-year-old male, complaining of progressive dysphagia. Initial esophagogastroscopy revealed a stenosis secondary to external compression, biopsies were inconclusive. Additional CT scan showed a large mediastinal mass of unknown origin, situated between the vertebrae and esophagus. Symptoms progressed and patient developed dyspnea and stridor. A new CT showed quick growth of the mass with compression of the trachea, subglottic to just above the carina. A tracheal covered stent was successfully placed. Endobronchial ultrasound revealed a large irregular mass without tracheal invasion, biopsies were taken. 4 days after stent placement, the patients’ condition deteriorated with worsening of stridor, dyspnea and desaturation. Migration of the tracheal stent into the right main bronchus was seen on chest X ray, with obstruction of the left main bronchus and secondary atelectasis. Different methods have been described in the literature for tracheobronchial stent removal (surgical, endoscopic, fluoroscopyguided), our first choice in this case was flexible bronchoscopy. However, this revealed tracheal compression above the migrated stent and passage of the scope occurred impossible. Patient was admitted to the ICU, high-flow nasal oxygen therapy was started and the situation stabilized, giving time for extensive assessment and preparation of the airway management approach. Close cooperation between the intensivist, pulmonologist, anesthesiologist and otorhinolaryngologist was essential. Results: In case of sudden deterioration, a protocol for emergency situations was made. Given the increased risk of additional tracheal compression after administration of neuromuscular blocking agents, an approach with awake fiberoptic intubation maintaining spontaneous ventilation was proposed. However, intubation without retrieval of the tracheal stent was found undesirable due to expected massive shunting over the left atelectatic lung. As rescue option, assistance of extracorporeal circulation was considered and perfusionist was kept on standby. The patient stayed stable and was transferred to the operating theatre. High frequency jet ventilation under general anesthesia resulted in desaturations up to 50%, making rigid bronchoscopy impossible. Subsequently an endotracheal tube size 8 could be placed successfully and the stent could be retrieved via bronchoscopy over (and with) the tube, after which the patient was reintubated. Finally, a tracheostomy (Shiley™ Tracheostomy Tube With Cuff, size 8) was placed, fiberoptic control showed a patent airway. Patient was readmitted to the ICU and could be quickly weaned of the ventilator. Pathology was positive for rhabdomyosarcoma, without indication for systemic therapy. Extensive surgery (laryngectomy, esophagectomy) was suggested, but patient refused and palliative care was started. Conclusion: Due to meticulous planning in an interdisciplinary team, we showed a successful airway management approach in this complicated case of critical airway compression secondary to a rare rhabdomyosarcoma, complicated by tracheal stent migration. Besides presenting our thoughts and considerations, we support exploring other possible approaches of this specific clinical problem.

Keywords: airway management, rhabdomyosarcoma, stent displacement, tracheal stenosis

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Authors: Salam N. Abdo, Orien L. Tulp, George P. Einstein

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The purpose of this exploratory study was to gather the insights into psoriasis etiology, treatment, and patient experience, for developing psoriasis and psoriatic arthritis diagnostic test. Data collection methods consisted of a comprehensive meta-analysis of relevant studies and psoriasis patient survey. Established meta-analysis guidelines were used for the selection and qualitative comparative analysis of psoriasis and psoriatic arthritis research studies. Only studies that clearly discussed psoriasis etiology, treatment, and patient experience were reviewed and analyzed, to establish a qualitative data base for the study. Using the insights gained from meta-analysis, an existing psoriasis patient survey was modified and administered to collect additional data as well as triangulate the results. The hypothesis is that specific types of psoriatic disease have specific etiology and pathophysiologic pattern. The following etiology categories were identified: bacterial, environmental/microbial, genetic, immune, infectious, trauma/stress, and viral. Additional results, obtained from meta-analysis and confirmed by patient survey, were the common age of onset (early to mid-20s) and type of psoriasis (plaque; mild; symmetrical; scalp, chest, and extremities, specifically elbows and knees). Almost 70% of patients reported no prescription drug use due to severe side effects and prohibitive cost. These results will guide the development of psoriasis and psoriatic arthritis diagnostic test. The significant number of medical publications classified psoriatic arthritis disease as inflammatory of an unknown etiology. Thus numerous meta-analyses struggle to report any meaningful conclusions since no definitive results have been reported to date. Therefore, return to the basics is an essential step to any future meaningful results. To date, medical literature supports the fact that psoriatic disease in its current classification could be misidentifying subcategories, which in turn hinders the success of studies conducted to date. Moreover, there has been an enormous commercial support to pursue various immune-modulation therapies, thus following a narrow hypothesis/mechanism of action that is yet to yield resolution of disease state. Recurrence and complications may be considered unacceptable in a significant number of these studies. The aim of the ongoing study is to focus on a narrow subgroup of patient population, as identified by this exploratory study via meta-analysis and patient survey, and conduct an exhaustive work up, aiming at mechanism of action and causality before proposing a cure or therapeutic modality. Remission in psoriasis has been achieved and documented in medical literature, such as immune-modulation, phototherapy, various over-the-counter agents, including salts and tar. However, there is no psoriasis and psoriatic arthritis diagnostic test to date, to guide the diagnosis and treatment of this debilitating and, thus far, incurable disease. Because psoriasis affects approximately 2% of population, the results of this study may affect the treatment and improve the quality of life of a significant number of psoriasis patients, potentially millions of patients in the United States alone and many more millions worldwide.

Keywords: biologics, early diagnosis, etiology, immune disease, immune modulation therapy, inflammation skin disorder, phototherapy, plaque psoriasis, psoriasis, psoriasis classification, psoriasis disease marker, psoriasis diagnostic test, psoriasis marker, psoriasis mechanism of action, psoriasis treatment, psoriatic arthritis, psoriatic disease, psoriatic disease marker, psoriatic patient experience, psoriatic patient quality of life, remission, salt therapy, targeted immune therapy

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Authors: Arzyana Sunkar, Yanto Santosa, Siti Badriyah Rushayati

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Indonesia has experienced annual forest fires that have rapidly destroyed and degraded its forests. Fires in the peat swamp forests of Riau Province, have set the stage for problems to worsen, this being the ecosystem most prone to fires (which are also the most difficult, to extinguish). Despite various efforts to curb deforestation, and forest degradation processes, severe forest fires are still occurring. To find an effective solution, the basic causes of the problems must be identified. It is therefore critical to have an in-depth understanding of the underlying causal factors that have contributed to deforestation and forest degradation as a whole, in order to attain reductions in their rates. An assessment of the drivers of deforestation and forest degradation was carried out, in order to design and implement measures that could slow these destructive processes. Research was conducted in Giam Siak Kecil–Bukit Batu Biosphere Reserve (GSKBB BR), in the Riau Province of Sumatera, Indonesia. A biosphere reserve was selected as the study site because such reserves aim to reconcile conservation with sustainable development. A biosphere reserve should promote a range of local human activities, together with development values that are in line spatially and economically with the area conservation values, through use of a zoning system. Moreover, GSKBB BR is an area with vast peatlands, and is experiencing forest fires annually. Various factors were analysed to assess the drivers of deforestation and forest degradation in GSKBB BR; data were collected from focus group discussions with stakeholders, key informant interviews with key stakeholders, field observation and a literature review. Landsat satellite imagery was used to map forest-cover changes for various periods. Analysis of landsat images, taken during the period 2010-2014, revealed that within the non-protected area of core zone, there was a trend towards decreasing peat swamp forest areas, increasing land clearance, and increasing areas of community oil-palm and rubber plantations. Fire was used for land clearing and most of the forest fires occurred in the most populous area (the transition area). The study found a relationship between the deforested/ degraded areas, and certain distance variables, i.e. distance from roads, villages and the borders between the core area and the buffer zone. The further the distance from the core area of the reserve, the higher was the degree of deforestation and forest degradation. Research findings suggested that agricultural expansion may be the direct cause of deforestation and forest degradation in the reserve, whereas socio-economic factors were the underlying driver of forest cover changes; such factors consisting of a combination of socio-cultural, infrastructural, technological, institutional (policy and governance), demographic (population pressure) and economic (market demand) considerations. These findings indicated that local factors/problems were the critical causes of deforestation and degradation in GSKBB BR. This research therefore concluded that reductions in deforestation and forest degradation in GSKBB BR could be achieved through ‘local actor’-tailored approaches such as community empowerment

Keywords: Actor-led solution, community empowerment, drivers of deforestation and forest degradation, Giam Siak Kecil – Bukit Batu Biosphere Reserve

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Authors: Alemayehu Hailemicael Mezgebe, A. J. Solomon Raju

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Context: Lake Chamo is a significant lake in the Ethiopian Rift Valley, known for its diversity of wildlife and vegetation. However, the lake is facing various threats due to human activities and global effects. The poor management of resources could lead to food insecurity, ecological degradation, and loss of biodiversity. Research Aim: The aim of this study is to analyze the environmental implications of lake level changes using GIS and remote sensing. The research also aims to examine the floristic composition of the lakeside vegetation and propose spatially oriented environmental planning for the sustainable utilization of the biodiversity resources. Methodology: The study utilizes multi-temporal satellite images and aerial photographs to analyze the changes in the lake area over the past 45 years. Geospatial analysis techniques are employed to assess land use and land cover changes and change detection matrix. The composition and role of the lakeside vegetation in the ecological and hydrological functions are also examined. Findings: The analysis reveals that the lake has shrunk by 14.42% over the years, with significant modifications to its upstream segment. The study identifies various threats to the lake-wetland ecosystem, including changes in water chemistry, overfishing, and poor waste management. The study also highlights the impact of human activities on the lake's limnology, with an increase in conductivity, salinity, and alkalinity. Floristic composition analysis of the lake-wetland ecosystem showed definite pattern of the vegetation distribution. The vegetation composition can be generally categorized into three belts namely, the herbaceous belt, the legume belt and the bush-shrub-small trees belt. The vegetation belts collectively act as different-sized sieve screen system and calm down the pace of incoming foreign matter. This stratified vegetation provides vital information to decide the management interventions for the sustainability of lake-wetland ecosystem.Theoretical Importance: The study contributes to the understanding of the environmental changes and threats faced by Lake Chamo. It provides insights into the impact of human activities on the lake-wetland ecosystem and emphasizes the need for sustainable resource management. Data Collection and Analysis Procedures: The study utilizes aerial photographs, satellite imagery, and field observations to collect data. Geospatial analysis techniques are employed to process and analyze the data, including land use/land cover changes and change detection matrices. Floristic composition analysis is conducted to assess the vegetation patterns Question Addressed: The study addresses the question of how lake level changes and human activities impact the environmental health and biodiversity of Lake Chamo. It also explores the potential opportunities and threats related to water utilization and waste management. Conclusion: The study recommends the implementation of spatially oriented environmental planning to ensure the sustainable utilization and maintenance of Lake Chamo's biodiversity resources. It emphasizes the need for proper waste management, improved irrigation facilities, and a buffer zone with specific vegetation patterns to restore and protect the lake outskirt.

Keywords: buffer zone, geo-spatial, lake chamo, lake level changes, sustainable utilization

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Authors: Taikchan Lildar, Ayesha Samad, Suraj Sookhu

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Atrial fibrillation with rapid ventricular response results in the loss of atrial kick and shortened ventricular filling time, which often leads to decompensated heart failure. Pharmacologic rhythm control is the treatment of choice, and patients frequently benefit from the restoration of sinus rhythm. When pharmacologic treatment is unsuccessful or a patient declines hemodynamically, direct cardioversion is the treatment of choice. Torsades de pointes or “twisting of the points'' in French, is a rare but under-appreciated risk of cardioversion therapy and accounts for a significant number of sudden cardiac death each year. A 61-year-old female with no significant past medical history presented to the Emergency Department with worsening dyspnea. An electrocardiogram showed atrial fibrillation with rapid ventricular response, and a chest X-ray was significant for bilateral pulmonary vascular congestion. Full-dose anticoagulation and diuresis were initiated with moderate improvement in symptoms. A transthoracic echocardiogram revealed biventricular systolic dysfunction with a left ventricular ejection fraction of 30%. After consultation with an electrophysiologist, the consensus was to proceed with the restoration of sinus rhythm, which would likely improve the patient’s heart failure symptoms and possibly the ejection fraction. A transesophageal echocardiogram was negative for left atrial appendage thrombus; the patient was treated with a loading dose of amiodarone and underwent successful direct current cardioversion with 200 Joules. The patient was placed on telemetry monitoring for 24 hours and was noted to have frequent premature ventricular contractions with subsequent degeneration to torsades de pointes. The patient was found unresponsive and pulseless; cardiopulmonary resuscitation was initiated with cardioversion, and return of spontaneous circulation was achieved after four minutes to normal sinus rhythm. Post-cardiac arrest electrocardiogram showed sinus bradycardia with heart-rate corrected QT interval of 592 milliseconds. The patient continued to have frequent premature ventricular contractions and required two additional cardioversions to achieve a return of spontaneous circulation with intravenous magnesium and lidocaine. An automatic implantable cardioverter-defibrillator was subsequently implanted for secondary prevention of sudden cardiac death. The backup pacing rate of the automatic implantable cardioverter-defibrillator was set higher than usual in an attempt to prevent premature ventricular contractions-induced torsades de pointes. The patient did not have any further ventricular arrhythmias after implantation of the automatic implantable cardioverter-defibrillator. Overdrive pacing is a method utilized to treat premature ventricular contractions-induced torsades de pointes by preventing a patient’s susceptibility to R on T-wave-induced ventricular arrhythmias. Pacing at a rate of 90 beats per minute succeeded in controlling the arrhythmia without the need for traumatic cardiac defibrillation. In our patient, conversion of atrial fibrillation with rapid ventricular response to normal sinus rhythm resulted in a slower heart rate and an increased probability of premature ventricular contraction occurring on the T-wave and ensuing ventricular arrhythmia. This case highlights direct current cardioversion for atrial fibrillation with rapid ventricular response resulting in persistent ventricular arrhythmia requiring an automatic implantable cardioverter-defibrillator placement with overdrive pacing to prevent a recurrence.

Keywords: refractory atrial fibrillation, atrial fibrillation, overdrive pacing, torsades de pointes

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Authors: Kasun P. Wijayaratna, Lauren Gardner, Taha Hossein Rashidi

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Undergraduate students entering university across the last 2 to 3 years tend to be born during the middle years of the 1990s. This generation of students has been exposed to the internet and the desire and dependency on technology since childhood. Brains develop based on environmental influences and technology has wired this generation of student to be attuned to sophisticated complex visual imagery, indicating visual forms of learning may be more effective than the traditional lecture or discussion formats. Furthermore, post-millennials perspectives on career are not focused solely on stability and income but are strongly driven by interest, entrepreneurship and innovation. Accordingly, it is important for educators to acknowledge the generational shift and tailor the delivery of learning material to meet the expectations of the students and the needs of industry. In the context of transport engineering, effectively teaching undergraduate students the basic principles of transport planning, traffic engineering and highway design is fundamental to the progression of the profession from a practice and research perspective. Recent developments in technology have transformed the discipline as practitioners and researchers move away from the traditional “pen and paper” approach to methods involving the use of computer programs and simulation. Further, enhanced accessibility of technology for students has changed the way they understand and learn material being delivered at tertiary education institutions. As a consequence, blended learning approaches, which aim to integrate face to face teaching with flexible self-paced learning resources, have become prevalent to provide scalable education that satisfies the expectations of students. This research study involved the development of a series of ‘Blended Learning’ initiatives implemented within an introductory transport planning and geometric design course, CVEN2401: Sustainable Transport and Highway Engineering, taught at the University of New South Wales, Australia. CVEN2401 was modified by conducting interactive polling exercises during lectures, including weekly online quizzes, offering a series of supplementary learning videos, and implementing a realistic design project that students needed to complete using modelling software that is widely used in practice. These activities and resources were aimed to improve the learning environment for a large class size in excess of 450 students and to ensure that practical industry valued skills were introduced. The case study compared the 2016 and 2017 student cohorts based on their performance across assessment tasks as well as their reception to the material revealed through student feedback surveys. The initiatives were well received with a number of students commenting on the ability to complete self-paced learning and an appreciation of the exposure to a realistic design project. From an educator’s perspective, blending the course made it feasible to interact and engage with students. Personalised learning opportunities were made available whilst delivering a considerable volume of complex content essential for all undergraduate Civil and Environmental Engineering students. Overall, this case study highlights the value of blended learning initiatives, especially in the context of large class size university courses.

Keywords: blended learning, highway design, teaching, transport planning

Procedia PDF Downloads 141

Authors: Aidan Ryan, Nahima Miah, Sahaj Kaur, Imogen Sutherland, Mohamed Saleh

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Pulmonary symptoms are a common presentation to the emergency department. Due to a lack of understanding of the underlying pathophysiology, chronic liver disease is not often considered a cause of dyspnea. We present three patients who were admitted with significant respiratory distress secondary to hepatopulmonary syndrome, portopulmonary hypertension, and hepatic hydrothorax. The first is a 27-year-old male with a 6-month history of progressive dyspnea. The patient developed a severe type 1 respiratory failure with a PaO₂ of 6.3kPa and was escalated to critical care, where he was managed with non-invasive ventilation to maintain oxygen saturation. He had an agitated saline contrast echocardiogram, which showed the presence of a possible shunt. A CT angiogram revealed significant liver cirrhosis, portal hypertension, and large para esophageal varices. Ultrasound of the abdomen showed coarse liver echo patter and enlarged spleen. Along with these imaging findings, his biochemistry demonstrated impaired synthetic liver function with an elevated international normalized ratio (INR) of 1.4 and hypoalbuminaemia of 28g/L. The patient was then transferred to a tertiary center for further management. Further investigations confirmed a shunt of 56%, and liver biopsy confirmed cirrhosis suggestive of alpha-1-antitripsyin deficiency. The findings were consistent with a diagnosis of hepatopulmonary syndrome, and the patient is awaiting a liver transplant. The second patient is a 56-year-old male with a 12-month history of worsening dyspnoea, jaundice, confusion. His medical history included liver cirrhosis, portal hypertension, and grade 1 oesophageal varices secondary to significant alcohol excess. On admission, he developed a type 1 respiratory failure with PaO₂ of 6.8kPa requiring 10L of oxygen. CT pulmonary angiogram was negative for pulmonary embolism but showed evidence of chronic pulmonary hypertension, liver cirrhosis, and portal hypertension. An echocardiogram revealed a grossly dilated right heart with reduced function, pulmonary and tricuspid regurgitation, and pulmonary artery pressures estimated at 78mmHg. His biochemical markers showed impaired synthetic liver function with an INR of 3.2, albumin of 29g/L, along with raised bilirubin of 148mg/dL. During his long admission, he was managed with diuretics with little improvement. After three weeks, he was diagnosed with portopulmonary hypertension and was commenced on terlipressin. This resulted in successfully weaning off oxygen, and he was discharged home. The third patient is a 61-year-old male who presented to the local ambulatory care unit for therapeutic paracentesis on a background of decompensated liver cirrhosis. On presenting, he complained of a 2-day history of worsening dyspnoea and a productive cough. Chest x-ray showed a large pleural effusion, increasing in size over the previous eight months, and his abdomen was visibly distended with ascitic fluid. Unfortunately, the patient deteriorated, developing a larger effusion along with an increase in oxygen demand, and passed away. Without underlying cardiorespiratory disease, in the presence of a persistent pleural effusion with underlying decompensated cirrhosis, he was diagnosed with hepatic hydrothorax. While each presented with dyspnoea, the cause and underlying pathophysiology differ significantly from case to case. By describing these complications, we hope to improve awareness and aid prompt and accurate diagnosis, vital for improving outcomes.

Keywords: dyspnea, hepatic hydrothorax, hepatopulmonary syndrome, portopulmonary syndrome

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Authors: Farid Risheq, M. Zaid Alrisheq, Shuaa Al-Sadoon, Karim Al-Faqih, Mays Abdulazeez

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Breast cancer is the most frequently diagnosed cancer worldwide, and a common cause of death among women. Various conventional anatomical imaging tools are utilized for diagnosis, histological assessment and TNM (Tumor, Node, Metastases) staging of breast cancer. Biopsy of sentinel lymph node is becoming an alternative to the axillary lymph node dissection. Advances in 18-Fluoro-Deoxi-Glucose Positron Emission Tomography/Computed Tomography (18FDG-PET/CT) imaging have facilitated breast cancer diagnosis utilizing biological trapping of 18FDG inside lesion cells, expressed as Standardized Uptake Value (SUVmax). Objective: To present the utility of 18FDG uptake PET/CT scans in detecting active extra lymph nodes and distant occult metastases for breast cancer staging. Subjects and Methods: Four female patients were presented with initially classified TNM stages of breast cancer based on conventional anatomical diagnostic techniques. 18FDG-PET/CT scans were performed one hour post 18FDG intra-venous injection of (300-370) MBq, and (7-8) bed/130sec. Transverse, sagittal, and coronal views; fused PET/CT and MIP modality were reconstructed for each patient. Results: A total of twenty four lesions in breast, extended lesions to lung, liver, bone and active extra lymph nodes were detected among patients. The initial TNM stage was significantly changed post 18FDG-PET/CT scan for each patient, as follows: Patient-1: Initial TNM-stage: T1N1M0-(stage I). Finding: Two lesions in right breast (3.2cm2, SUVmax=10.2), (1.8cm2, SUVmax=6.7), associated with metastases to two right axillary lymph nodes. Final TNM-stage: T1N2M0-(stage II). Patient-2: Initial TNM-stage: T2N2M0-(stage III). Finding: Right breast lesion (6.1cm2, SUVmax=15.2), associated with metastases to right internal mammary lymph node, two right axillary lymph nodes, and sclerotic lesions in right scapula. Final TNM-stage: T2N3M1-(stage IV). Patient-3: Initial TNM-stage: T2N0M1-(stage III). Finding: Left breast lesion (11.1cm2, SUVmax=18.8), associated with metastases to two lymph nodes in left hilum, and three lesions in both lungs. Final TNM-stage: T2N2M1-(stage IV). Patient-4: Initial TNM-stage: T4N1M1-(stage III). Finding: Four lesions in upper outer quadrant area of right breast (largest: 12.7cm2, SUVmax=18.6), in addition to one lesion in left breast (4.8cm2, SUVmax=7.1), associated with metastases to multiple lesions in liver (largest: 11.4cm2, SUV=8.0), and two bony-lytic lesions in left scapula and cervicle-1. No evidence of regional or distant lymph node involvement. Final TNM-stage: T4N0M2-(stage IV). Conclusions: Our results demonstrated that 18FDG-PET/CT scans had significantly changed the TNM stages of breast cancer patients. While the T factor was unchanged, N and M factors showed significant variations. A single session of PET/CT scan was effective in detecting active extra lymph nodes and distant occult metastases, which were not identified by conventional diagnostic techniques, and might advantageously replace bone scan, and contrast enhanced CT of chest, abdomen and pelvis. Applying 18FDG-PET/CT scan early in the investigation, might shorten diagnosis time, helps deciding adequate treatment protocol, and could improve patients’ quality of life and survival. Trapping of 18FDG in malignant lesion cells, after a PET/CT scan, increases the retention index (RI%) for a considerable time, which might help localize sentinel lymph node for biopsy using a hand held gamma probe detector. Future work is required to demonstrate its utility.

Keywords: axillary lymph nodes, breast cancer staging, fluorodeoxyglucose positron emission tomography/computed tomography, lymph nodes

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Authors: Nursuhaili Najwa Masrol, Nur Hafizah Mohammed, Nur Nadhirah Rusyda Rosnan, Vijaya Subramaniam, Sim Choon Cheak

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Replanting in oil palm cultivation is vital to enable the introduction of planting materials and provides an opportunity to improve the road, drainage, terrace design, and planting density. Oil palm replanting is fundamentally necessary every 25 years. The adoption of the digital replanting blueprint is imperative as it can assist the Malaysia Oil Palm industry in addressing challenges such as labour shortages and limited expertise related to replanting tasks. Effective replanting planning should commence at least 6 months prior to the actual replanting process. Therefore, this study will help to plan and design the replanting blueprint with high-precision translation on the ground. With the advancement of geospatial technology, it is now feasible to engage in thoroughly researched planning, which can help maximize the potential yield. A blueprint designed before replanting is to enhance management’s ability to optimize the planting program, address manpower issues, or even increase productivity. In terrace planting blueprints, geographic tools have been utilized to design the roads, drainages, terraces, and planting points based on the ARM standards. These designs are mapped with location information and undergo statistical analysis. The geospatial approach is essential in precision agriculture and ensuring an accurate translation of design to the ground by implementing high-accuracy technologies. In this study, geospatial and remote sensing technologies played a vital role. LiDAR data was employed to determine the Digital Elevation Model (DEM), enabling the precise selection of terraces, while ortho imagery was used for validation purposes. Throughout the designing process, Geographical Information System (GIS) tools were extensively utilized. To assess the design’s reliability on the ground compared with the current conventional method, high-precision GPS instruments like EOS Arrow Gold and HIPER VR GNSS were used, with both offering accuracy levels between 0.3 cm and 0.5cm. Nearest Distance Analysis was generated to compare the design with actual planting on the ground. The analysis revealed that it could not be applied to the roads due to discrepancies between actual roads and the blueprint design, which resulted in minimal variance. In contrast, the terraces closely adhered to the GPS markings, with the most variance distance being less than 0.5 meters compared to actual terraces constructed. Considering the required slope degrees for terrace planting, which must be greater than 6 degrees, the study found that approximately 65% of the terracing was constructed at a 12-degree slope, while over 50% of the terracing was constructed at slopes exceeding the minimum degrees. Utilizing blueprint replanting promising strategies for optimizing land utilization in agriculture. This approach harnesses technology and meticulous planning to yield advantages, including increased efficiency, enhanced sustainability, and cost reduction. From this study, practical implementation of this technique can lead to tangible and significant improvements in agricultural sectors. In boosting further efficiencies, future initiatives will require more sophisticated techniques and the incorporation of precision GPS devices for upcoming blueprint replanting projects besides strategic progression aims to guarantee the precision of both blueprint design stages and its subsequent implementation on the field. Looking ahead, automating digital blueprints are necessary to reduce time, workforce, and costs in commercial production.

Keywords: replanting, geospatial, precision agriculture, blueprint

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Authors: Mariza Kaskara, Stella Girtsou, Maria Prodromou, Alexia Tsouni, Christodoulos Mettas, Stavroula Alatza, Kyriaki Fotiou, Marios Tzouvaras, Charalampos Kontoes, Diofantos Hadjimitsis

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Natural hazard assessment and monitoring are crucial components in managing the risks associated with fires, floods, and geohazards, particularly in regions prone to these natural disasters, such as Greece and Cyprus. Recent advancements in technology led to the development of state-of-the-art systems for assessing and monitoring these hazards. These technologies, developed by the BEYOND Center of Excellence of the National Observatory of Athens, have been successfully applied in Greece and are now set to be transferred to Cyprus. The implementation of these advanced technologies in Greece has significantly improved the country's ability to respond to these natural hazards. Enhancing disaster resilience is crucial as it significantly improves our ability to predict, prepare for, and mitigate the impacts of natural disasters, ultimately saving lives and reducing economic losses. For wildfire risk assessment, a scalar wildfire occurrence risk index has been created based on the predictions of machine learning models. Our objective was to train an ML model that learns to derive a fire susceptibility score when given as input a vector of features assigned to certain spatiotemporal coordinates. Predicting fire danger is crucial for the sustainable management of forest fires as it provides essential information for designing effective prevention measures and facilitating response planning for potential fire incidents. For flood risk assessment, a multi-faceted approach has been employed, including the application of remote sensing techniques, the collection and processing of data from population, buildings, technical studies and field visits, as well as hydrological and hydraulic simulations. All input data are used to create precise flood hazard maps according to various flooding scenarios, detailed flood vulnerability and flood exposure maps, which finally produce the flood risk map. Critical points are identified, and mitigation measures are proposed for the worst-case scenario, namely, refuge areas are defined, and escape routes are designed. Flood risk maps can assist in raising awareness and save lives. For geohazards monitoring (e.g., landslides, subsidence), synthetic aperture radar (SAR) and optical satellite imagery have been combined with geomorphological and meteorological data and other landslide/ground deformation contributing factors. To monitor critical infrastructures, including dams, advanced InSAR (Interferometric SAR) methodologies are used for identifying surface movements through time. Monitoring these hazards provides valuable information for understanding processes and could lead to early warning systems to protect people and infrastructure. The success of these systems in Greece has paved the way for their transfer to Cyprus to enhance Cyprus's capabilities in natural hazard assessment and monitoring. This transfer is being made through knowledge transfer activities, fostering continuous collaboration between Greek and Cypriot experts. Furthermore, small demonstration actions are implemented to showcase the effectiveness of these technologies in real-world scenarios. In conclusion, the transfer of advanced natural hazard assessment technologies from Greece to Cyprus represents a significant step forward in enhancing the entire region's resilience to disasters. The EXCELSIOR project, funding this opportunity, is committed to empowering Cyprus with the tools and expertise needed to effectively manage and mitigate the risks associated with these natural hazards. Acknowledgment: Authors acknowledge the 'EXCELSIOR': ERATOSTHENES: Excellence Research Centre for Earth Surveillance and Space-Based Monitoring of the Environment H2020 Widespread Teaming project.

Keywords: earth observation, monitoring, natural hazards, remote sensing

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