Search results for: major adverse cardiac events
9831 Designing Creative Events with Deconstructivism Approach
Authors: Maryam Memarian, Mahmood Naghizadeh
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Deconstruction is an approach that is entirely incompatible with the traditional prevalent architecture. Considering the fact that this approach attempts to put architecture in sharp contrast with its opposite events and transpires with attending to the neglected and missing aspects of architecture and deconstructing its stable structures. It also recklessly proceeds beyond the existing frameworks and intends to create a different and more efficient prospect for space. The aim of deconstruction architecture is to satisfy both the prospective and retrospective visions as well as takes into account all tastes of the present in order to transcend time. Likewise, it ventures to fragment the facts and symbols of the past and extract new concepts from within their heart, which coincide with today’s circumstances. Since this approach is an attempt to surpass the limits of the prevalent architecture, it can be employed to design places in which creative events occur and imagination and ambition flourish. Thought-provoking artistic events can grow and mature in such places and be represented in the best way possible to all people. The concept of event proposed in the plan grows out of the interaction between space and creation. In addition to triggering surprise and high impressions, it is also considered as a bold journey into the suspended realms of the traditional conflicts in architecture such as architecture-landscape, interior-exterior, center-margin, product-process, and stability-instability. In this project, at first, through interpretive-historical research method and examining the inputs and data collection, recognition and organizing takes place. After evaluating the obtained data using deductive reasoning, the data is eventually interpreted. Given the fact that the research topic is in its infancy and there is not a similar case in Iran with limited number of corresponding instances across the world, the selected topic helps to shed lights on the unrevealed and neglected parts in architecture. Similarly, criticizing, investigating and comparing specific and highly prized cases in other countries with the project under study can serve as an introduction into this architecture style.Keywords: anti-architecture, creativity, deconstruction, event
Procedia PDF Downloads 3159830 Reliving Historical Events Using Augmented Reality Techniques
Authors: Josep Domenech Mingot, Francisco Javier Esclapes Jover
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The arrival of the age of information and new technologies allowed humanity to see what the future has in store, but occasionally it also brings the opportunity to look through a window to the past, an opportunity to relive history. This paper introduces a prototype of a digital system that lets us peek into our past making use of augmented reality technologies. A 3D scene will be modeled and animated based on an old image, depicting an event of historical significance. From this scene, a video will be rendered, recreating the events that were taking place at the time. Also, a smartphone app will be created. This app will detect the original image with the smartphone’s camera, overlay the rendered video so that it fully covers it and track the detected image, so that the overlaying video can keep covering the image. The recreation of Alicante’s Central Market bombing during the Spanish Civil War is presented as a case study.Keywords: augmented reality, digital heritage, history, multimedia, smartphone
Procedia PDF Downloads 2139829 Caught in the Crossfire : Natural Resources, Energy Transition, and Conflict in the Democratic Republic of Congo
Authors: Koami West Togbetse
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The global shift towards clean and sustainable energy sources, known as the energy transition, is compelling numerous countries to transition from polluting energy systems to cleaner alternatives, commonly referred to as green energies. In this context, cobalt holds significant importance as a crucial mineral in facilitating this energy transition due to its pivotal role in electric batteries. Considering the Democratic Republic of Congo’s reputation for political instability and its position as the largest producer of cobalt, possessing over 50% of the world’s reserves, we have assessed the potential conflicts that may arise as a result of the rapid increase in cobalt demand. The results show that cobalt does not appear to be a determinant contributing to all past conflicts over the study period in the Democratic Republic of Congo (DRC). Gold, on the other hand, stands out as one of the coveted metals for rebel groups engaged in rampant exploitation, increasing the likelihood of conflicts occurring. However, a more in-depth analysis reveals a shift in the relationship between cobalt production and conflict events around 2006. Prior to 2006, increased cobalt production was significantly associated with a reduction in conflict events. However, after 2006, this relationship became positive, indicating that higher cobalt production is now linked to a slight increase in conflict events. This suggests a change in the dynamics affecting conflicts related to cobalt production before and after 2006. According to our predictive model, cobalt has the potential to emerge increasingly as a contributing factor, just like gold.Keywords: conflicts, natural resources, energy transition, geopolitics
Procedia PDF Downloads 259828 Investigating a Crack in Care: Assessing Long-Term Impacts of Child Abuse and Neglect
Authors: Remya Radhakrishnan, Hema Perinbanathan, Anukriti Rath, Reshmi Ramachandran, Rohith Thazhathuvetil Sasindrababu, Maria Karizhenskaia
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Childhood adversities have lasting effects on health and well-being. This abstract explores the connection between adverse childhood experiences (ACEs) and health consequences, including substance abuse and obesity. Understanding the impact of childhood trauma and emphasizing the importance of culturally sensitive treatments and focused interventions help to mitigate these effects. Research consistently shows a strong link between ACEs and poor health outcomes. Our team conducted a comprehensive literature review of depression and anxiety in Canadian children and youth, exploring diverse treatment methods, including medical, psychotherapy, and alternative therapies like art and music therapy. We searched Medline, Google Scholar, and St. Lawrence College Library. Only original research papers, published between 2012 and 2023, peer-reviewed, and reporting on childhood adversities on health and its treatment methods in children and youth in Canada were considered. We focused on their significance in treating depression and anxiety. According to the study's findings, the prevalence of adverse childhood experiences (ACEs) is still a significant concern. In Canada, 40% of people report having had multiple ACEs, and 78% report having had at least one ACE, highlighting the persistence of childhood adversity and indicating that the issue is unlikely to fade off in the near future. Likewise, findings revealed that individuals who experienced abuse, neglect, or violence during childhood are likelier to engage in harmful behaviors like polydrug use, suicidal ideation, and victimization and suffer from mental health problems such as depression and post-traumatic stress disorder (PTSD).Keywords: adverse childhood experiences (ACEs), obesity, post-traumatic stress disorder (PTSD), resilience, substance abuse, trauma-informed care
Procedia PDF Downloads 1139827 Important role of HLA-B*58:01 Allele and Distribution Among Healthy Thais: Avoid Severe Cutaneous Adverse Reactions
Authors: Jaomai Tungsiripat, Patompong Satapornpong
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Allopurinol have been used to treat diseases that relating with the reduction of uric acid and be a treatment preventing the severity of, including gout, chronic kidney disease, chronic heart failure, and diabetes mellitus (type 2). However, allopurinol metabolites can cause a severe cutaneous adverse reaction (SCARs) consist of Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) and Stevens-Johnson Syndrome(SJS)/Toxic Epidermal Necrolysis (TEN). Previous studies, we found only HLA-B*58:01 allele has a strongly association with allopurinol-induced SCARs in many populations: Han Chinese [P value = 4.7 x 10−24], European [P value <10−6], and Thai [P value <0.001].However, there was no update the frequency of HLA-B alleles and pharmacogenetics markers distribution in healthy Thais and support for screening before the initiation of treatment. The aim of this study was to investigate the prevalence of HLA-B*58:01 allele associated with allopurinol-induced SCARs in healthy Thai population. A retrospective study of 260 individual healthy subjects who living in Thailand. HLA-B were genotyped using sequence-specific oligonucleotides (PCR-SSOs).In this study, we identified the prevalence of HLA-B alleles consist ofHLA-B*46:01 (12.69%), HLA-B*15:02 (8.85%), HLA-B*13:01 (6.35%), HLA-B*40:01 (6.35%), HLA-B*38:02 (5.00%), HLA-B*51:01 (5.00%), HLA-B*58:01 (4.81%), HLA-B*44:03 (4.62%), HLA-B*18:01 (3.85%) and HLA-B*15:25 (3.08%). Therefore, the distribution of HLA-B*58:01 will support the clinical implementation and screening usage of allopurinol in Thai population.Keywords: allopurinol, HLA-B*58: 01, Thai population, SCARs
Procedia PDF Downloads 1339826 Inflating the Public: A Series of Urban Interventions
Authors: Veronika Antoniou, Rene Carraz, Yiorgos Hadjichristou
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The Green Urban Lab took the form of public installations that were placed at various locations in four cities in Cyprus. These installations - through which a series of events, activities, workshops and research took place - were the main tools in regenerating a series of urban public spaces in Cyprus. The purpose of this project was to identify issues and opportunities related to public space and to offer guidelines on how design and participatory democracy improvements could strengthen civil society, while raising the quality of the urban public scene. Giant inflatable structures were injected in important urban fragments in order to accommodate series of events. The design and playful installation generated a wide community engagement. The fluid presence of the installations acted as a catalyst for social interaction. They were accessed and viewed effortlessly and surprisingly, creating opportunities to rediscover public spaces.Keywords: bottom-up initiatives, creativity, public space, social innovation, urban environments
Procedia PDF Downloads 5109825 Time Overrun in Pre-Construction Planning Phase of Construction Projects
Authors: Hafiz Usama Imad, Muhammad Akram Akhund, Tauha Hussain Ali, Ali Raza Khoso, Fida Hussain Siddiqui
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Construction industry plays a significant role in fulfilling the major requirements of the human being. It is one of the major constituents of every developed country. Although the construction industry of both the developing and developed countries encompasses a major part of the economy, and millions of rupees are utilized every year on various kinds of construction projects. But, this industry is facing numerous hurdles in terms of its budget and timely completion. Construction projects generally consist of several phases like planning, designing, execution, and finishing. This research study aims to determine the significant factors of time overrun in pre-construction planning (PCP) phase of construction projects in Pakistan. Questionnaires were distributed by various means and responses of respondents were compiled and collected data were then analyzed through a statistical technique using SPSS version 24. Major causes of time overrun in pre-construction planning phase; which is an extremely important phase of construction projects, were revealed. The research conclusion will provide a pathway for stakeholders to pay attention to the mentioned causes to overcome the major issue of time overrun.Keywords: construction industry, Pakistan, pre-construction planning phase, time overrun
Procedia PDF Downloads 2469824 Satellite Images to Determine Levels of Fire Severity in a Native Chilean Forest: Assessing the Responses of Soil Mesofauna Diversity to a Fire Event
Authors: Carolina Morales, Ricardo Castro-Huerta, Enrique A. Mundaca
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The edaphic fauna is the main factor involved in the transformation of nutrients and soil decomposition processes. Edaphic organisms are highly sensitive to soil disturbances, which normally causes changes in the composition and abundance of such organisms. Fire is known to be a disturbing factor since it affects the physical, chemical and biological properties of the soil and the whole ecosystem. During the summer (December-March) of 2017, Chile suffered the major fire events recorded in its modern history, which affected a vast area and a number of ecosystem types. The objective of this study was first to use remote sensing satellite images and GIS (Geographic Information Systems) to assess and identify levels of fire severity in disturbed areas and to compare the responses of the soil mesofauna diversity among such areas. We identified four areas (treatments) with an ascending level of severity, namely: mild, medium, high severity, and free of fire. A non-affected patch of forest was established as a control. Three samples from each treatment were collected in the form of a soil cube (10x10x10 cm). Edaphic mesofauna was obtained from each sample through the Berlese-Tullgren funnel method. Collected specimens were quantified and identified, using the RTU (Recognisable Taxonomic Unit) criterion. Diversity was analysed using inferential statistics to compare Simpson and Shannon-Wiener indexes across treatments. As predicted, the unburned forest patch (control) exhibited higher diversity values than the treatments. Significantly higher diversity values were recorded in those treatments subjected to lower fire severity. We conclude that remote sensing zoning is an adequate tool to identify different levels of fire severity and that an edaphic mesofauna is a group of organisms that qualify as good bioindicators for monitoring soil recovery after fire events.Keywords: bioindicator, Chile, fire severity level, soil
Procedia PDF Downloads 1529823 Harvard Lawyers Perception of Intellectual Property and Digital Rights
Authors: Dariusz Jemielniak
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The near future will bring significant changes to contemporary organizations and management, because of the rapidly increasing role of immaterial goods and knowledge workers. The area of copyright, IP, as well as digital (non-material) goods and media redistribution seems to be one of the major challenges for the economy and society in general, and management and organization studies in particular. The proposed paper shows the views and perceptions of fairness of digital media sharing among Harvard Law School LL.M. students, basing on 50 qualitative interviews and 100 questionnaires. The researcher took an ethnographic approach to the study and joined the 2016 Harvard LL.M. Facebook group, which allowed natural socializing and joining for in-person events and private parties more easily. After making acquaintance with many of the students, the researcher conducted a quantitative questionnaire with 100 respondents, allowing to better understand the respondents perception of fairness in digital files sharing in different contexts (depending on the price of the media, its availability, regional licensing, status of the copyright holder, etc.). Basing on the results of the questionnaire, the researcher followed up with long-term, open ended, loosely structured ethnographic interviews (50 interviews were conducted) to further deepen the understanding of the results. The major finding of the study is that Harvard lawyers, in spite of the highest possible understanding of law, as well as professional standards, generally approve of digital piracy in certain contexts. Interestingly, they are also more likely to approve of it if they work for the government rather than the private sector. The conclusions from this study allow a better understanding of how ‘fairness’ is perceived by the younger generation of law professionals, and also open grounds for a more rational licensing policing.Keywords: piracy, digital sharing, perception of fairness, legal profession
Procedia PDF Downloads 2179822 The Foundation Binary-Signals Mechanics and Actual-Information Model of Universe
Authors: Elsadig Naseraddeen Ahmed Mohamed
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In contrast to the uncertainty and complementary principle, it will be shown in the present paper that the probability of the simultaneous occupation event of any definite values of coordinates by any definite values of momentum and energy at any definite instance of time can be described by a binary definite function equivalent to the difference between their numbers of occupation and evacuation epochs up to that time and also equivalent to the number of exchanges between those occupation and evacuation epochs up to that times modulus two, these binary definite quantities can be defined at all point in the time’s real-line so it form a binary signal represent a complete mechanical description of physical reality, the time of these exchanges represent the boundary of occupation and evacuation epochs from which we can calculate these binary signals using the fact that the time of universe events actually extends in the positive and negative of time’s real-line in one direction of extension when these number of exchanges increase, so there exists noninvertible transformation matrix can be defined as the matrix multiplication of invertible rotation matrix and noninvertible scaling matrix change the direction and magnitude of exchange event vector respectively, these noninvertible transformation will be called actual transformation in contrast to information transformations by which we can navigate the universe’s events transformed by actual transformations backward and forward in time’s real-line, so these information transformations will be derived as an elements of a group can be associated to their corresponded actual transformations. The actual and information model of the universe will be derived by assuming the existence of time instance zero before and at which there is no coordinate occupied by any definite values of momentum and energy, and then after that time, the universe begin its expanding in spacetime, this assumption makes the need for the existence of Laplace’s demon who at one moment can measure the positions and momentums of all constituent particle of the universe and then use the law of classical mechanics to predict all future and past of universe’s events, superfluous, we only need for the establishment of our analog to digital converters to sense the binary signals that determine the boundaries of occupation and evacuation epochs of the definite values of coordinates relative to its origin by the definite values of momentum and energy as present events of the universe from them we can predict approximately in high precision it's past and future events.Keywords: binary-signal mechanics, actual-information model of the universe, actual-transformation, information-transformation, uncertainty principle, Laplace's demon
Procedia PDF Downloads 1719821 Gradient-Based Reliability Optimization of Integrated Energy Systems Under Extreme Weather Conditions: A Case Study in Ningbo, China
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Recent extreme weather events, such as the 2021 European floods and North American heatwaves, have exposed the vulnerability of energy systems to both extreme demand scenarios and potential physical damage. Current integrated energy system designs often overlook performance under these challenging conditions. This research, focusing on a regional integrated energy system in Ningbo, China, proposes a distinct design method to optimize system reliability during extreme events. A multi-scenario model was developed, encompassing various extreme load conditions and potential system damages caused by severe weather. Based on this model, a comprehensive reliability improvement scheme was designed, incorporating a gradient approach to address different levels of disaster severity through the integration of advanced technologies like distributed energy storage. The scheme's effectiveness was validated through Monte Carlo simulations. Results demonstrate significant enhancements in energy supply reliability and peak load reduction capability under extreme scenarios. The findings provide several insights for improving energy system adaptability in the face of climate-induced challenges, offering valuable references for building reliable energy infrastructure capable of withstanding both extreme demands and physical threats across a spectrum of disaster intensities.Keywords: extreme weather events, integrated energy systems, reliability improvement, climate change adaptation
Procedia PDF Downloads 59820 A Case of Survival with Self-Draining Haemopericardium Secondary to Stabbing
Authors: Balakrishna Valluru, Ruth Suckling
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A 16 year old male was found collapsed on the road following stab injuries to the chest and abdomen and was transported to the emergency department by ambulance. On arrival in the emergency department the patient was breathless and appeared pale. He was maintaining his airway with spontaneous breathing and had a heart rate of 122 beats per minute with a blood pressure of 83/63 mmHg. He was resuscitated initially with three units of packed red cells. Clinical examination identified three incisional wounds each measuring 2 cm. These were in the left para-sternal region, right infra-scapular region and left upper quadrant of the abdomen. The chest wound over the left parasternal area at the level of 4tth intercostal space was bleeding intermittently on leaning forwards and was relieving his breathlessness intermittently. CT imaging was performed to characterize his injuries and determine his management. CT scan of chest and abdomen showed moderate size haemopericardium with left sided haemopneumothorax. The patient underwent urgent surgical repair of the left ventricle and left anterior descending artery. He recovered without complications and was discharged from the hospital. This case highlights the fact that the potential to develop a life threatening cardiac tamponade was mitigated by the left parasternal stab wound. This injury fortuitously provided a pericardial window through which the bleeding from the injured left ventricle and left anterior descending artery could drain into the left hemithorax providing an opportunity for timely surgical intervention to repair the cardiac injuries.Keywords: stab, incisional, haemo-pericardium, haemo-pneumothorax
Procedia PDF Downloads 1979819 Clinical Response of Nuberol Forte® (Paracetamol 650 MG+Orphenadrine 50 MG) For Pain Management with Musculoskeletal Conditions in Routine Pakistani Practice (NFORTE-EFFECT)
Authors: Shahid Noor, Kazim Najjad, Muhammad Nasir, Irshad Bhutto, Abdul Samad Memon, Khurram Anwar, Tehseen Riaz, Mian Muhammad Hanif, Nauman A. Mallik, Saeed Ahmed, Israr Ahmed, Ali Yasir
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Background: Musculoskeletal pain is the most common complaint presented to the health practitioner. It is well known that untreated or under-treated pain can have a significant negative impact on an individual’s quality of life (QoL). Objectives: This study was conducted across 10 sites in six (6) major cities of Pakistan to evaluate the tolerability, safety, and the clinical response of Nuberol Forte® (Paracetamol 650 mg + Orphenadrine 50 mg) to musculoskeletal pain in routine Pakistani practice and its impact on improving the patient’s QoL. Design & Methods: This NFORT-EFFECT observational, prospective multicenter study was conducted in compliance with Good Clinical Practice guidelines and local regulatory requirements. The study sponsor was "The Searle Company Limited, Pakistan. To maintain the GCP compliances, the sponsor assigned the CRO for the site and data management. Ethical approval was obtained from an independent ethics committee. The IEC reviewed the progress of the study. Written informed consent was obtained from the study participants, and their confidentiality was maintained throughout the study. A total of 399 patients with known prescreened musculoskeletal conditions and pain who attended the study sites were recruited, as per the inclusion/exclusion criteria (clinicaltrials.gov ID# NCT04765787). The recruited patients were then prescribed Paracetamol (650 mg) and Orphenadrine (50 mg) combination (Nuberol Forte®) for 7 to 14 days as per the investigator's discretion based on the pain intensity. After the initial screening (visit 1), a follow-up visit was conducted after 1-2 weeks of the treatment (visit 2). Study Endpoints: The primary objective was to assess the pain management response of Nuberol Forte treatment and the overall safety of the drug. The Visual Analogue Scale (VAS) scale was used to measure pain severity. Secondary to pain, the patients' health-related quality of life (HRQoL) was also assessed using the Muscle, Joint Measure (MJM) scale. The safety was monitored on the first dose by the patients. These assessments were done on each study visit. Results: Out of 399 enrolled patients, 49.4% were males, and 50.6% were females with a mean age of 47.24 ± 14.20 years. Most patients were presented with Knee Osteoarthritis (OA), i.e., 148(38%), followed by backache 70(18.2%). A significant reduction in the mean pain score was observed after the treatment with the combination of Paracetamol and Orphenadrine (p<0.05). Furthermore, an overall improvement in the patient’s QoL was also observed. During the study, only ten patients reported mild adverse events (AEs). Conclusion: The combination of Paracetamol and Orphenadrine (Nuberol Forte®) exhibited effective pain management among patients with musculoskeletal conditions and also improved their QoL.Keywords: musculoskeletal pain, orphenadrine/paracetamol combination, pain management, quality of life, Pakistani population
Procedia PDF Downloads 1659818 Foregrounding Events in Modern Sundanese: The Pragmatics of Particle-to-Active Voice Marking Shift
Authors: Rama Munajat
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Discourse information levels may be viewed from either a background-foreground distinction or a multi-level perspective, and cross-linguistic studies on this area suggest that each information level is marked by a specific linguistic device. In this sense, Sundanese, spoken in Indonesia’s West Javanese Province, further differentiates the background and foreground information into ordinary and significant types. This paper will report an ongoing shift from particle-to-active voice marking in the way Sundanese signals foregrounding events. The shift relates to decades of contact with Bahasa Indonesia (Indonesia’s official language) and linguistic compatibility between the two surface marking strategies. Representative data analyzed include three groups of short stories in both Sundanese and Bahasa Indonesia (Indonesian) published in three periods: before 1945, 1965-2006, and 2016-2019. In the first group of Sundanese data, forward-moving events dominantly appear in particle KA (Kecap Anteuran, word-accompanying) constructions, where the KA represents different particles that co-occur with a special group of verbs. The second group, however, shows that the foregrounded events are more frequently described in active-voice forms with a subject-predicate (SP) order. Subsequently, the third offers stronger evidence for the use of the SP structure. As for the Indonesian data, the foregrounding events in the first group occur in verb-initial and passive-voice constructions, while in the second and third, the events more frequently appear in active-voice structures (subject-predicate sequence). The marking shift above suggests a structural influence from Indonesian, stemmed from generational differences among authors of the Sundanese short stories, particularly related to their education and language backgrounds. The first group of short stories – published before 1945 or before Indonesia's independence from Dutch – were written by native speakers of Sundanese who spoke Indonesian as a foreign language and went through the Dutch education system. The second group of authors, on the other hand, represents a generation of Sundanese native speakers who spoke Indonesian as a second language. Finally, the third group consists of authors who are bilingual speakers of both Sundanese and Indonesian. The data suggest that the last two groups of authors completed the Indonesian education system. With these, the use of subject-predicate sequences to denote foregrounding events began to appear more frequently in the second group and then became more dominant in those of the third. The coded data also signify that cohesion, coherence, and pragmatic purposes in Particle KA constructions are intact in their respective active-voice structure counterparts. For instance, the foregrounding events in Particle KA constructions occur in Sentence-initial KA and Pre-verbal KA forms, whereas those in the active-voice are described in Subject-Predicate (SP) and Zero-Subject active-voice patterns. Cross-language data further demonstrate that the Sentence-initial KA and the SP active-voice structures each contain an overt noun phrase (NP) co-referential with one of the entities introduced in a preceding context. Similarly, the pre-verbal KA and Zero-Subject active-voice patterns have a deleted noun phrase unambiguously referable to the only one entity previously mentioned. The presence and absence of an NP inform a pragmatic strategy to place prominence on topic/given and comment/new information, respectively.Keywords: discourse analysis, foregrounding marking, pragmatics, language contact
Procedia PDF Downloads 1269817 Unsupervised Echocardiogram View Detection via Autoencoder-Based Representation Learning
Authors: Andrea Treviño Gavito, Diego Klabjan, Sanjiv J. Shah
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Echocardiograms serve as pivotal resources for clinicians in diagnosing cardiac conditions, offering non-invasive insights into a heart’s structure and function. When echocardiographic studies are conducted, no standardized labeling of the acquired views is performed. Employing machine learning algorithms for automated echocardiogram view detection has emerged as a promising solution to enhance efficiency in echocardiogram use for diagnosis. However, existing approaches predominantly rely on supervised learning, necessitating labor-intensive expert labeling. In this paper, we introduce a fully unsupervised echocardiographic view detection framework that leverages convolutional autoencoders to obtain lower dimensional representations and the K-means algorithm for clustering them into view-related groups. Our approach focuses on discriminative patches from echocardiographic frames. Additionally, we propose a trainable inverse average layer to optimize decoding of average operations. By integrating both public and proprietary datasets, we obtain a marked improvement in model performance when compared to utilizing a proprietary dataset alone. Our experiments show boosts of 15.5% in accuracy and 9.0% in the F-1 score for frame-based clustering, and 25.9% in accuracy and 19.8% in the F-1 score for view-based clustering. Our research highlights the potential of unsupervised learning methodologies and the utilization of open-sourced data in addressing the complexities of echocardiogram interpretation, paving the way for more accurate and efficient cardiac diagnoses.Keywords: artificial intelligence, echocardiographic view detection, echocardiography, machine learning, self-supervised representation learning, unsupervised learning
Procedia PDF Downloads 209816 Lipschitz Classifiers Ensembles: Usage for Classification of Target Events in C-OTDR Monitoring Systems
Authors: Andrey V. Timofeev
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This paper introduces an original method for guaranteed estimation of the accuracy of an ensemble of Lipschitz classifiers. The solution was obtained as a finite closed set of alternative hypotheses, which contains an object of classification with a probability of not less than the specified value. Thus, the classification is represented by a set of hypothetical classes. In this case, the smaller the cardinality of the discrete set of hypothetical classes is, the higher is the classification accuracy. Experiments have shown that if the cardinality of the classifiers ensemble is increased then the cardinality of this set of hypothetical classes is reduced. The problem of the guaranteed estimation of the accuracy of an ensemble of Lipschitz classifiers is relevant in the multichannel classification of target events in C-OTDR monitoring systems. Results of suggested approach practical usage to accuracy control in C-OTDR monitoring systems are present.Keywords: Lipschitz classifiers, confidence set, C-OTDR monitoring, classifiers accuracy, classifiers ensemble
Procedia PDF Downloads 4879815 Developing a Viral Artifact to Improve Employees’ Security Behavior
Authors: Stefan Bauer, Josef Frysak
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According to the scientific information management literature, the improper use of information technology (e.g. personal computers) by employees are one main cause for operational and information security loss events. Therefore, organizations implement information security awareness programs to increase employees’ awareness to further prevention of loss events. However, in many cases these information security awareness programs consist of conventional delivery methods like posters, leaflets, or internal messages to make employees aware of information security policies. We assume that a viral information security awareness video might be more effective medium than conventional methods commonly used by organizations. The purpose of this research is to develop a viral video artifact to improve employee security behavior concerning information technology.Keywords: information security awareness, delivery methods, viral videos, employee security behavior
Procedia PDF Downloads 5369814 An Assessment of the Effects of Microbial Products on the Specific Oxygen Uptake in Submerged Membrane Bioreactor
Authors: M. F. R. Zuthi, H. H. Ngo, W. S. Guo, S. S. Chen, N. C. Nguyen, L. J. Deng, T. D. C Tran
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Sustaining a desired rate of oxygen transfer for microbial activity is a matter of major concern for Biological Wastewater Treatment (MBR). The study reported in the paper was aimed at assessing the effects of microbial products on the Specific Oxygen Uptake Rate (SOUR) in a Conventional Membrane Bioreactor (CMBR) and that in a Sponge Submerged MBR (SSMBR). The production and progressive accumulation of Soluble Microbial Products (SMP) and Bound-Extracellular Polymeric Substances (BEPS) were found affecting the SOUR of the microorganisms which varied at different stages of operation of the MBR systems depending on the variable concentrations of the SMP/bEPS. The effect of bEPS on the SOUR was stronger in the SSMBR compared to that of the SMP, while relative high concentrations of SMP had adverse effects on the SOUR of the CMBR system. Of the different mathematical correlations analyzed in the study, logarithmic mathematical correlations could be established between SOUR and bEPS in SSMBR, and similar correlations could also be found between SOUR and SMP concentrations in the CMBR.Keywords: microbial products, microbial activity, specific oxygen uptake rate, membrane bioreactor
Procedia PDF Downloads 3009813 Perception of Healthcare Workers Regarding the Psychological Impact of COVID-19 on Their Children
Authors: Saima Batool, Saima Rafique
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Background and Objective: Pandemics like COVID-19 adversely affect children’s behavior and psychological development by disrupting routine life activities. Children of healthcare workers are exposed additionally due to the fear of parental exposure to the virus. The objective of this study was to assess the perception of frontline healthcare workers (HCWs) regarding the psychological impact of the COVID-19 pandemic on their children. We also sought to identify the difference in the psychological impact on children of male and female healthcare workers. Methods: A survey questionnaire was developed comprising 10 questions about the perception of HCWs regarding the psychological impact of COVID-19 on their children. It was distributed both online and face-to-face among 150 healthcare professionals working in training and non-training posts in 4 public and 5 nongovernment hospitals in Pakistan. The mean and standard deviation were calculated for each survey item using Statistical Package for the Social Sciences 26.0. Results: The response rate was 71.3%, and the majority (64.2%) of the healthcare professionals were ≥30 years of age. Ninety-two HCWs (85.98%) either agreed or strongly agreed that parental separation from their kids for long hours during the pandemic had a negative psychological impact on their children. There was a significant difference in the perceived psychological impact of COVID-19 on the children of male and female HCWs, with a mean survey score of 2.29 ± 1.82 and 1.69 ± 0.79, respectively (t = 2.29, p-value = 0.024). Conclusion: Children of healthcare workers experience more stress and anxiety because of long duty hours and working in high-risk settings. Continuous psychological support and counseling services may be adopted formally to prevent unforeseen adverse events or any long-term negative impact on their physical and mental health.Keywords: healthcare workers, pandemic, COVID-19, anxiety, psychological
Procedia PDF Downloads 469812 Cognitive Emotion Regulation Strategies in 9–14-Year-Old Hungarian Children with Neurotypical Development in the Light of the Hungarian Version of Cognitive Emotion Regulation Questionnaire for Children
Authors: Dorottya Horváth, Andras Lang, Diana Varro-Horvath
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This research activity and study is part of a major research effort to gain an integrative, neuropsychological, and personality psychological understanding of Attention Deficit Hyperactivity Disorder (ADHD) and thus improve the specification of diagnostic and therapeutic care. In the past, the neuropsychology section has investigated working memory, executive function, attention, and behavioural manifestations in children. Currently, we are looking for personality psychological protective factors for ADHD and its symptomatic exacerbation. We hypothesise that secure attachment, adaptive emotion regulation, and high resilience are protective factors. The aim of this study is to measure and report the results of a Hungarian sample of the Cognitive Emotion Regulation Questionnaire for Children (CERQ-k) because before studying groups with different developmental differences, it is essential to know the average scores of groups with neurotypical devel-opment. Until now, there was no Hungarian version of the above test, so we used our own translation. This questionnaire has been developed to assess children's thoughts after experiencing negative life events. It consists of 4-4 items per subscale, for a total of 36 items. The response categories for each item range from 1 (almost never) to 5 (almost always). The subscales were self-blame, blaming others, acceptance, planning, positive refocusing, rumination or thought-focusing, positive reappraisal, putting into perspective, and catastrophizing. The data for this study were collected from 120 children aged 9-14 years. It was analysed using descriptive statistical analysis, where the mean and standard deviation values for each age group, as well as the Cronbach's alpha value, were significant in testing the reliability of the questionnaire. The results showed that the questionnaire is a reliable and valid measuring instrument also on a Hungarian sample. These developments and results will allow the use of a version of the Cognitive Emotion Regulation Questionnaire for children in Hungarian and pave the way for the study of different developmental groups such as children with learning disabilities and/or with ADHD.Keywords: neurotypical development, emotion regulation, negative life events, CERQ-k, Hungarian average scores
Procedia PDF Downloads 669811 Assessment of Physical Activity Patterns in Patients with Cardiopulmonary Diseases
Authors: Ledi Neçaj
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Objectives: The target of this paper is (1) to explain objectively physical activity model throughout three chronic cardiopulmonary conditions, and (2) to study the connection among physical activity dimensions with disease severity, self-reported physical and emotional functioning, and exercise performance. Material and Methods: This is a cross-sectional study of patients in their domestic environment. Patients with cardiopulmonary diseases were: chronic obstructive pulmonary disease (COPD), (n-63), coronary heart failure (n=60), and patients with implantable cardioverter defibrillator (n=60). Main results measures: Seven ambulatory physical activity dimensions (total steps, percentage time active, percentage time ambulating at low, medium, and hard intensity, maximum cadence for 30 non-stop minutes, and peak performance) have been measured with an accelerometer. Results: Subjects with COPD had the lowest amount of ambulatory physical activity compared with topics with coronary heart failure and cardiac dysrhythmias (all 7 interest dimensions, P<.05); total step counts have been: 5319 as opposed to 7464 as opposed to 9570, respectively. Six-minute walk distance becomes correlated (r=.44-.65, P<.01) with all physical activity dimensions inside the COPD pattern, the most powerful correlations being with total steps and peak performance. In topics with cardiac impairment, maximal oxygen intake had the most effective small to slight correlations with five of the physical activity dimensions (r=.22-.40, P<.05). In contrast, correlations among 6-minute walk test distance and physical activity have been higher (r=.48-.61, P<.01) albeit in a smaller pattern of most effective patients with coronary heart failure. For all three samples, self-reported physical and mental health functioning, age, frame mass index, airflow obstruction, and ejection fraction had both exceptionally small and no significant correlations with physical activity. Conclusions: Findings from this study present a profitable benchmark of physical activity patterns in individuals with cardiopulmonary diseases for comparison with future studies. All seven dimensions of ambulatory physical activity have disfavor between subjects with COPD, heart failure, and cardiac dysrhythmias. Depending on the research or clinical goal, the use of one dimension, such as total steps, may be sufficient. Although physical activity had high correlations with performance on a six-minute walk test relative to other variables, accelerometers-based physical activity monitoring provides unique, important information about real-world behavior in patients with cardiopulmonary not already captured with existing measures.Keywords: ambulatory physical activity, walking, monitoring, COPD, heart failure, implantable defibrillator, exercise performance
Procedia PDF Downloads 829810 Application of Metarhizium anisopliae against Meloidogyne javanica in Soil Amended with Oak Debris
Authors: Mohammad Abdollahi
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Tomato (Lycopersicon esculentum Mill.) is one of the most popular, widely grown and the second most important vegetable crop, after potatoes. Nematodes have been identified as one of the major pests affecting tomato production throughout the world. The most destructive nematodes are the genus Meloidogyne. Most widespread and devastating species of this genus are M. incognita, M. javanica, and M. arenaria. These species can cause complete crop loss under adverse growing conditions. There are several potential methods for management of the root knot nematodes. Although the chemicals are widely used against the phytonematodes, because of hazardous effects of these compounds on non-target organisms and on the environment, there is a need to develop other control strategies. Nowadays, non-chemical measures are widely used to control the plant parasitic nematodes. Biocontrol of phytonematodes is an important method among environment-friendly measures of nematode management. There are some soil-inhabiting fungi that have biocontrol potential on phytonematodes, which can be used in nematode management program. The fungus Metarhizium anisopliae, originally is an entomopathogenic bioagent. Biocontrol potential of this fungus on some phytonematodes has been reported earlier. Recently, use of organic soil amendments as well as the use of bioagents is under special attention in sustainable agriculture. This research aimed to reduce the pesticide use in control of root-knot nematode, Meloidogyne javanica in tomato. The effects of M. anisopliae IMI 330189 and different levels of oak tree debris on M. javanica were determined. The combination effect of the fungus as well as the different rates of soil amendments was determined. Pots were filled with steam pasteurized soil mixture and the six leaf tomato seedlings were inoculated with 3000 second stage larvae of M. javanica/kg of soil. After eight weeks, plant growth parameters and nematode reproduction factors were compared. Based on the results of our experiment, combination of M. anisopliae IMI 330189 and oak debris caused more than 90% reduction in reproduction factor of nematode, at the rates of 100 and 150 g/kg soil (P ≤ 0.05). As compared to control, the reduction in number of galls was 76%. It was 86% for nematode reproduction factor, showing the significance of combined effect of both tested agents. Our results showed that plant debris can increase the biological activity of the tested bioagent. It was also proved that there was no adverse effect of oak debris, which potentially has antimicrobial activity, on antagonistic power of applied bioagent.Keywords: biological control, nematode management, organic soil, Quercus branti, root knot nematode, soil amendment
Procedia PDF Downloads 1689809 Prediction of Super-Response to Cardiac Resynchronisation Therapy
Authors: Vadim A. Kuznetsov, Anna M. Soldatova, Tatyana N. Enina, Elena A. Gorbatenko, Dmitrii V. Krinochkin
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The aim of the study was to evaluate potential parameters related with super-response to CRT. Methods: 60 CRT patients (mean age 54.3 ± 9.8 years; 80% men) with congestive heart failure (CHF) II-IV NYHA functional class, left ventricular ejection fraction < 35% were enrolled. At baseline, 1 month, 3 months and each 6 months after implantation clinical, electrocardiographic and echocardiographic parameters, NT-proBNP level were evaluated. According to the best decrease of left ventricular end-systolic volume (LVESV) (mean follow-up period 33.7 ± 15.1 months) patients were classified as super-responders (SR) (n=28; reduction in LVESV ≥ 30%) and non-SR (n=32; reduction in LVESV < 30%). Results: At baseline groups differed in age (58.1 ± 5.8 years in SR vs 50.8 ± 11.4 years in non-SR; p=0.003), gender (female gender 32.1% vs 9.4% respectively; p=0.028), width of QRS complex (157.6 ± 40.6 ms in SR vs 137.6 ± 33.9 ms in non-SR; p=0.044). Percentage of LBBB was equal between groups (75% in SR vs 59.4% in non-SR; p=0.274). All parameters of mechanical dyssynchrony were higher in SR, but only difference in left ventricular pre-ejection period (LVPEP) was statistically significant (153.0 ± 35.9 ms vs. 129.3 ± 28.7 ms p=0.032). NT-proBNP level was lower in SR (1581 ± 1369 pg/ml vs 3024 ± 2431 pg/ml; p=0.006). The survival rates were 100% in SR and 90.6% in non-SR (log-rank test P=0.002). Multiple logistic regression analysis showed that LVPEP (HR 1.024; 95% CI 1.004–1.044; P = 0.017), baseline NT-proBNP level (HR 0.628; 95% CI 0.414–0.953; P=0.029) and age at baseline (HR 1.094; 95% CI 1.009-1.168; P=0.30) were independent predictors for CRT super-response. ROC curve analysis demonstrated sensitivity 71.9% and specificity 82.1% (AUC=0.827; p < 0.001) of this model in prediction of super-response to CRT. Conclusion: Super-response to CRT is associated with better survival in long-term period. Presence of LBBB was not associated with super-response. LVPEP, NT-proBNP level, and age at baseline can be used as independent predictors of CRT super-response.Keywords: cardiac resynchronisation therapy, superresponse, congestive heart failure, left bundle branch block
Procedia PDF Downloads 3899808 An Australian Tertiary Centre Experience of Complex Endovascular Aortic Repairs
Authors: Hansraj Bookun, Rachel Xuan, Angela Tan, Kejia Wang, Animesh Singla, David Kim, Christopher Loupos, Jim Iliopoulos
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Introduction: Complex endovascular aortic aneursymal repairs with fenestrated and branched endografts require customised devices to exclude the pathology while reducing morbidity and mortality, which was historically associated with open repair of complex aneurysms. Such endovascular procedures have predominantly been performed in a large volume dedicated tertiary centres. We present here our nine year multidisciplinary experience with this technology in an Australian tertiary centre. Method: This was a cross-sectional, single-centre observational study of 670 patients who had undergone complex endovascular aortic aneurysmal repairs with conventional endografts, fenestrated endografts, and iliac-branched devices from January 2010 to July 2019. Descriptive statistics were used to characterise our sample with regards to demographic and perioperative variables. Homogeneity of the sample was tested using multivariant regression, which did not identify any statistically significant confounding variables. Results: 670 patients of mean age 74, were included (592 males) and the comorbid burden was as follows: ischemic heart disease (55%), diabetes (18%), hypertension (90%), stage four or greater kidney impairment (8%) and current or ex-smoking (78%). The main indications for surgery were elective aneurysms (86%), symptomatic aneurysms (5%), and rupture aneurysms (5%). 106 patients (16%) underwent fenestrated or branched endograft repairs. The mean length of stay was 7.6 days. 2 patients experienced reactionary bleeds, 11 patients had access wound complications (6 lymph fistulae, 5 haematoms), 11 patients had cardiac complications (5 arrhythmias, 3 acute myocadial infarctions, 3 exacerbation of congestive cardiac failure), 10 patients had respiratory complications, 8 patients had renal impairment, 4 patients had gastrointestinal complications, 2 patients suffered from paraplegia, 1 major stroke, 1 minor stroke, and 1 acute brain syndrome. There were 4 vascular occlusions requiring further arterial surgery, 4 type I endoleaks, 4 type II endoleaks, 3 episodes of thromboembolism, and 2 patients who required further arterial operations in the setting of patient vessels. There were 9 unplanned returns to the theatre. Discussion: Our numbers of 10 years suggest that we are not a dedicated high volume centre focusing on aortic repairs. However, we have achieved significantly low complication rates. This can be attributed to our multidisciplinary approach with the intraoperative involvement of skilled interventional radiologists and vascular surgeons as well as postoperative protocols with particular attention to spinal cord protection. Additionally, we have a ratified perioperative pathway that involves multidisciplinary team discussions of patient-related factors and lesion-centered characteristics, which allows for holistic, patient-centered care.Keywords: aneurysm, aortic, endovascular, fenestrated
Procedia PDF Downloads 1129807 Safety Profile of Anti-Retroviral Medicine in South Africa Based on Reported Adverse Drug Reactions
Authors: Sarah Gounden, Mukesh Dheda, Boikhutso Tlou, Elizabeth Ojewole, Frasia Oosthuizen
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Background: Antiretroviral therapy (ART) has been effective in the reduction of mortality and resulted in an improvement in the prognosis of HIV-infected patients. However, treatment with antiretrovirals (ARVs) has led to the development of many adverse drug reactions (ADRs). It is, therefore, necessary to determine the safety profile of these medicines in a South African population in order to ensure safe and optimal medicine use. Objectives: The aim of this study was to quantify ADRs experienced with the different ARVs currently used in South Africa, to determine the safety profile of ARV medicine in South Africa based on reported ADRs, and to determine the ARVs with the lowest risk profile based on specific patient populations. Methodology: This was a quantitative study. Individual case safety reports for the period January 2010 – December 2013 were obtained from the National Pharmacovigilance Center; these reports contained information on ADRs, ARV medicine, and patient demographics. Data was analysed to find associations that may exist between ADRs experienced, ARV medicines used and patient demographics. Results: A total of 1916 patient reports were received of which 1534 met the inclusion criteria for the study. The ARV with the lowest risk of ADRs were found to be lamivudine (0.51%, n=12), followed by lopinavir/ritonavir combination (0.8%, n=19) and abacavir (0.64%, n=15). A higher incidence of ADRs was observed in females compared to males. The age group 31–50 years and the weight group 61–80 kg had the highest incidence of ADRs reported. Conclusion: This study found that the safest ARVs to be used in a South African population are lamivudine, abacavir, and the lopinavir/ritonavir combination. Gender differences play a significant role in the occurrence of ADRs and both anatomical and physiological differences account for this. An increased BMI (body mass index) in both men and women showed an increase in the incidence of ADRs associated with ARV therapy.Keywords: adverse drug reaction, antiretrovirals, HIV/AIDS, pharmacovigilance, South Africa
Procedia PDF Downloads 3459806 The Scope and Effectiveness of Interactive Voice Response Technologies in Post-Operative Care
Authors: Zanib Nafees, Amir Razaghizad, Ibtisam Mahmoud, Abhinav Sharma, Renzo Cecere
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More than one million surgeries are performed each year in Canada, resulting in more than 100,000 associated serious adverse events (SAEs) per year. These are defined as unintended injuries or complications that adversely affect the well-being of patients. In recent years, there has been a proliferation of digital health interventions that have the potential to assist, monitor, and educate patients—facilitating self-care following post-operative discharge. Among digital health, interventions are interactive-voice response technologies (IVRs), which have been shown to be highly effective in certain medical settings. Although numerous IVR-based interventions have been developed, their effectiveness and utility remain unclear, notably in post-operative settings. To the best of our knowledge, no systematic or scoping reviews have evaluated this topic to date. Thus, the objective of this scoping review protocol is to systematically map and explore the literature and evidence describing and examining IVR tools, implementation, evaluation, outcome, and experience for post-operative patients. The focus will be primarily on the evaluation of baseline performance status, clinical assessment, treatment outcomes, and patient management, including self-management and self-monitoring. The objective of this scoping review is to assess the extent of the literature to direct future research efforts by identifying gaps and limitations in the literature and to highlight relevant determinants of positive outcomes in the emerging field of IVR monitoring for health outcomes in post-operative patients.Keywords: digital healthcare technologies, post-surgery, interactive voice technology, interactive voice response
Procedia PDF Downloads 2569805 Prevalence of Risk Factors of the Female Athlete Triad Among Young Elite Athletes of the World
Authors: Muhammad Saleem
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Background: Inattentive food choices and engagement in excessive physical activities by male athletes can potentially lead to adverse health consequences. Objective: The aim was to ascertain the occurrence of risk factors associated with the Male Athlete Triad among young elite athletes in Pakistan. Methodology: In 2018, a cross-sectional study based on questionnaires was conducted at the Pakistan Sports Board. The study aimed to explore the risk factors related to the Male Athlete Triad in young elite athletes who were part of national training camps in major metropolitan areas. The study included proficient male elite athletes aged 18 to 25 years, capable of understanding the English questionnaire. The athletes completed a survey encompassing aspects like demographic information, educational background, Body Mass Index (BMI), sports involvement, and hours of participation. Additionally, they filled out the Eating Attitude Test-26 (EAT-26) and questionnaires assessing risks of amenorrhea and low bone mineral density. The prevalence of risk factors for each of the three components was individually evaluated. The collected data underwent analysis using SPSS-20, with descriptive statistics being applied. Results: The study comprised a sample of 90 elite athletes (mean age: 23.57 ± 2.37 years, mean BMI: 21.97 ± 1.90) engaged in various sports. The EAT-26 results indicated that 50% of athletes were at risk of developing an eating disorder. Moreover, 83.3% exhibited disordered eating behaviors that necessitated referral. Risks for amenorrhea were observed in 15% of the participants, and regarding low bone mineral density, notable risks were absent except for the consumption of caffeinated beverages, which was noted in 51.7% of participants. Conclusion: The study identified a significant prevalence of disordered eating risk among male elite athletes in Pakistan. However, the risks associated with amenorrhea and low bone mineral density were not a major concern in this particular group.Keywords: Pakistan, osteoporosis, female athlete triad, bone mineral density, athlete, amenorrhea, eating disorders
Procedia PDF Downloads 599804 Maintenance Dredging at Port of Townsville
Authors: Mohamed Jaditager, Julie Lovisa, Nagaratnam Sivakugan
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The Port of Townsville conducts regular annual maintenance dredging to maintain depths of its harbor basin and approach channels for the navigational safety of the vessels against the natural accumulation of marine sediments. In addition to the regular maintenance dredging, the port undertakes emergency dredging in cases where large quantities of sediments are mobilized and deposited in port waters by cyclone or major flood events. The maintenance dredging material derived from the port may be disposed at sea or on land in accordance with relevant state and commonwealth regulations. For the land disposal, the dredged mud slurry is hydraulically placed into containment ponds and left to undergo sedimentation and self-weight consolidation to form fill material for land reclamation. This paper provides an overview of the maintenance dredging at the Port of Townsville and emphasis on maintenance dredging requirements, sediment quality, bathymetry, dredging methods used, and dredged material disposal options.Keywords: consolidation, dredged material, maintenance dredging, marine sediments, sedimentation
Procedia PDF Downloads 4359803 Working With Accessibility in Latvian Contemporary Art: Research, Barriers, and Implementation From a Curator’s and Production Manager’s Perspective
Authors: Agnese Zviedre
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In 2010 Latvia ratified the United Nations Convention on the Rights of Persons with Disabilities, which states that the state will recognize the importance of accessibility to the physical, social, and cultural environment. Nevertheless, accessibility of art and culture in Latvia has become a focal point only since 2020. A study on the impact of cultural consumption and participation done by the Latvian Academy of Culture and the research center “SKDS” results show that art and cultural institutions lack knowledge and understanding of needs and required accessibility measures for people with disabilities to participate in cultural and art events. At the same time, even if art institutions want to create accessible events for people with diverse bodies and minds, many barriers exist, such as budget, lack of time, and lack of knowledge. Even though disability is still largely invisible in the public space, due to recent public campaigns and awareness of the need for accessibility, the media and society are starting to speak about disability as a social issue, not a medical one. Thus, this paper focuses on the first-hand experience of implementing different Western accessibility guidelines and working with communities as a production manager for the multidisciplinary exhibition project “Invisible Lives” in Riga and curator of the education program of Riga Photography Biennial’s 2022 Central Event - Exhibition “Screen Age III: Still Life”. Analyzing two events from the Disability studies perspective, this paper focuses on working with existing knowledge and budget to achieve accessibility.Keywords: accessibility, contemporary art, curatorial practices, disability studies
Procedia PDF Downloads 889802 The Impact of Gestational Weight Gain on Subclinical Atherosclerosis, Placental Circulation and Neonatal Complications
Authors: Marina Shargorodsky
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Aim: Gestational weight gain (GWG) has been related to altering future weight-gain curves and increased risks of obesity later in life. Obesity may contribute to vascular atherosclerotic changes as well as excess cardiovascular morbidity and mortality observed in these patients. Noninvasive arterial testing, such as ultrasonographic measurement of carotid IMT, is considered a surrogate for systemic atherosclerotic disease burden and is predictive of cardiovascular events in asymptomatic individuals as well as recurrent events in patients with known cardiovascular disease. Currently, there is no consistent evidence regarding the vascular impact of excessive GWG. The present study was designed to investigate the impact of GWG on early atherosclerotic changes during late pregnancy, using intima-media thickness, as well as placental vascular circulation and inflammatory lesions and pregnancy outcomes. Methods: The study group consisted of 59 pregnant women who gave birth and underwent a placental histopathological examination at the Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Israel, in 2019. According to the IOM guidelines the study group has been divided into two groups: Group 1 included 32 women with pregnancy weight gain within recommended range; Group 2 included 27 women with excessive weight gain during pregnancy. The IMT was measured from non-diseased intimal and medial wall layers of the carotid artery on both sides, visualized by high-resolution 7.5 MHz ultrasound (Apogee CX Color, ATL). Placental histology subdivided placental findings to lesions consistent with maternal vascular and fetal vascular malperfusion according to the criteria of the Society for Pediatric Pathology, subdividing placental findings to lesions consistent with maternal vascular and fetal vascular malperfusion, as well as the inflammatory response of maternal and fetal origin. Results: IMT levels differed between groups and were significantly higher in Group 1 compared to Group 2 (0.7+/-0.1 vs 0.6+/-0/1, p=0.028). Multiple linear regression analysis of IMT included variables based on their associations in univariate analyses with a backward approach. Included in the model were pre-gestational BMI, HDL cholesterol and fasting glucose. The model was significant (p=0.001) and correctly classified 64.7% of study patients. In this model, pre-pregnancy BMI remained a significant independent predictor of subclinical atherosclerosis assessed by IMT (OR 4.314, 95% CI 0.0599-0.674, p=0.044). Among placental lesions related to fetal vascular malperfusion, villous changes consistent with fetal thrombo-occlusive disease (FTOD) were significantly higher in Group 1 than in Group 2, p=0.034). In Conclusion, the present study demonstrated that excessive weight gain during pregnancy is associated with an adverse effect on early stages of subclinical atherosclerosis, placental vascular circulation and neonatal complications. The precise mechanism for these vascular changes, as well as the overall clinical impact of weight control during pregnancy on IMT, placental vascular circulation as well as pregnancy outcomes, deserves further investigation.Keywords: obesity, pregnancy, complications, weight gain
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