Search results for: risk measure

Authors: Christine Ysabelle G. Roman, Pauline Torres

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Background: Hypertrophic cardiomyopathy is a disease of marked heterogeneity. It is a genetically determined heart disease characterized by significant myocardium hypertrophy that results in diastolic dysfunction, left ventricular outflow tract obstruction, and an increased risk of arrhythmias. The primary treatment in patients with such conditions is negative inotropic drugs, such as beta-blockers, calcium channel antagonists, and disopyramide. However, for those who remain symptomatic and need septal reduction therapy, surgical septal myectomy or alcohol septal ablation are options. Case Summary: A 19 – year old female presented in the authors’ institution with easy fatigability. The consult was done a year prior, and 2D echocardiography was requested which showed concentric left ventricular hypertrophy, asymmetrically hypertrophied interventricular septum (IVS) with the largest diameter of 3.3cm & subaortic dynamic obstruction with a maximum gradient of 47 mmHg. A repeat echo a year later showed asymmetric septal hypertrophy (IVS measuring at 3cm) with the systolic anterior motion of anterior mitral valve leaflet and left ventricular outflow tract obstruction (peak gradient of 50mmHg). The patient then underwent alcohol septal ablation and was discharged stable after four days of admission. Conclusion: Hypertrophic obstructive cardiomyopathy, a cardiovascular genetic disease, results in various patterns of left ventricular hypertrophy and abnormality of mitral valve apparatus. The patient is managed medically initially. However, despite optimal drug therapy and significant left ventricular outflow tract obstruction, significant heart failure symptoms or syncope require invasive treatment.

Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, alcohol septal ablation, alcohol

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Authors: Mette Pedersen

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This paper outlines the criteria that assessment specialists use when they design the 'Persuasive Essay' task for the four Advanced Placement World Language and Culture Exams (AP French, German, Italian, and Spanish). The 'Persuasive Essay' is a free-response, source-based, standardized measure of presentational writing. Each 'Persuasive Essay' item consists of three sources (an article, a chart, and an audio) and a prompt, which is a statement of the topic phrased as an interrogative sentence. Due to its richness of source materials and due to the amount of time that test takers are given to prepare for and write their responses (a total of 55 minutes), the 'Persuasive Essay' is the free-response task on the AP World Language and Culture Exams that goes to the greatest lengths to unleash the test takers' proficiency potential. The author focuses on the work that goes into designing the 'Persuasive Essay' task, outlining best practices for the selection of topics and sources, the interplay that needs to be present among the sources and the thinking behind the articulation of prompts for the 'Persuasive Essay' task. Using released 'Persuasive Essay' items from the AP World Language and Culture Exams and accompanying data on test taker performance, the author shows how different passages, and features of passages, have succeeded (and sometimes not succeeded) in eliciting writing proficiency among test takers over time. Data from approximately 215.000 test takers per year from 2014 to 2017 and approximately 35.000 test takers per year from 2012 to 2013 form the basis of this analysis. The conclusion of the study is that test taker performance improves significantly when the sources that test takers are presented with express directly opposing viewpoints. Test taker performance also improves when the interrogative prompt that the test takers respond to is phrased as a yes/no question. Finally, an analysis of linguistic difficulty and complexity levels of the printed sources reveals that test taker performance does not decrease when the complexity level of the article of the 'Persuasive Essay' increases. This last text complexity analysis is performed with the help of the 'ETS TextEvaluator' tool and the 'Complexity Scale for Information Texts (Scale)', two tools, which, in combination, provide a rubric and a fully-automated technology for evaluating nonfiction and informational texts in English translation.

Keywords: advanced placement world language and culture exams, designing presentational writing assessments, large-scale standardized assessments of written language proficiency, source-based language testing

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Authors: Okanlawon Simon Ayorinde, Odunjo Oluronke Omolola, Fadamiro Joseph Akinlabi, Adedibu Afolabi Adebgite

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A road is a path established over land, especially prepared way between places for the use of pedestrian, riders, and vehicles: a hard surface built for vehicles to travel on. The social, economic and health importance of roads in any community and nation cannot be underestimated. Roads provide access to properties and they also provide mobility which is ability to transport goods and services from one place to another. In the residential zones of many indigenous cities in Nigeria, roads are usually blocked for social ceremonies. Road blocked for ceremonies as used in this study are a temporary barrier across a road, used to stop or hinder traffic from passing through to the other side. Social ceremonies that could warrant road blockage include marriage, child naming, funeral, celebration of life’s achievement, birthday anniversary etc. These activities are likely to generate environmental hazards and their attendant risks. The assessment of these hazards and risks in residential zones of indigenous cities in Nigeria becomes imperative. The study is focused on Ogbomoso, Oyo State, Nigeria. The town has two local government councils namely Ogbomoso North and Ogbomoso South. Urban tracts that are easy to identify are political wards in the absence of land use segregation, houses numbering and street naming. The wards that had residential having a minimum of 60% of their land use components were surveyed and fifteen out of twenty wards identified in the town were surveyed. The study utilized primary data collected through questionnaire administration The three major road categories (Trunk A-Federal; Trunk B- State; Trunk C-Local) were identified and trunk C-Local roads were purposively selected being the concern of this study because they are the ones often blocked for social activities. The major stakeholders interviewed and the respective sampling methods are residents (random and systematic), social ceremony organizers (purposive), government officials (purposive) and road users namely commercial motorists and commercial motor cyclists (random and incidental). Data analysis was mainly descriptive. Two indices to measure respondents’ perception were developed. These are ‘Hazard Severity Index’ (HSI) and ‘Relative Awareness Index’ (RAI).Thereafter, policy implications and recommendations were provided.

Keywords: road, residential zones, indigenous cities, blocked, social ceremonies

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Authors: Ayesha Siddiqua

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Background: Hypertension is a silent killer disease and a common risk factor for considerable morbidity and mortality. Its effects can be seen on the organs like Heart; Brain; Kidneys. In Saudi Arabia, hypertension affects a sizeable enough proportion of the population, with a prevalence of 27.9% in urban and 22.4 in rural population. Despite these features, the magnitude and epidemiological characteristics of this disease have been rarely studied in Saudi Arabia. To fill this gap, we conducted a survey in Abha to study the KAP of hypertension. KAP study shows what people know about certain things, their feelings and behavior towards the disease management. An improvement in the Knowledge and Attitudes towards disease management can reform the kinds of practices which are followed. Objectives: To assess the level of Knowledge, Attitude and Practice of patients who suffer from Hypertension. To improve the Quality of life of patients. Methods: A prospective cross-sectional survey was conducted on a sample size of 130 Hypertensive patients of both the genders enrolled by simple random sampling technique admitted in the Aseer Central Hospital of Abha during the period from October 2016 to December 2016. Results: Altogether 130 hypertensive patients were enrolled in this study with equal no. of Males and Females. Most of the respondents were aged between 18-40 years (45%). On assessing the KAP of the patients, we found that the Knowledge and Attitude score was good but the Practice scores were moderate in both the genders. Conclusion: Our study concludes that a significant proportion of hypertensive patients show less Practice towards the disease management which can lead to severe complications in time being and also result in damage of other vital organs. So there is a need of intense educational intervention for the patients which can be done by Patient counselling by the clinical pharmacist. Strategies to modify lifestyle which help in control of hypertension can include providing leaflets as well as direct educational programs.

Keywords: Attitude, hypertension, Knowledge, practices

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Authors: Muhammad Naveed

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In this paper, flood issues in Gujranwala and Rawalpindi divisions are discussed as a primary importance as these zones are affected continuously from flooding in recent years, provincial variability of the issue, introduce status of the continuous administration measures, their adequacy and future needs in flood administration are secured. Flood issues in these zones are exhibited by Chenab River Basin, Jhelum Rivers Basin. Some unique problems, related to floods in these divisions is lack of major dams on Chenab and Jhelum rivers and also mismanagement of rivers and canal water like dam break stream, and water signing in Tal zones, are additionally mentioned. There are major Nalaas in these regions like Nalaa Lai of Rawalpindi and Nalaa Daik, Nalaa Palkhu, Nalaa Aik of Gujranwala are major cause of floods in these regions other than rivers. Proper management of these Nalaas and moving of nearby population well in time could reduce impacts from flood in these regions. Progress of different flood administration measures, both auxiliary and non-basic, are discussed. Likewise, future needs to accomplish proficient and fruitful flood management measures in Pakistan are additionally brought up. In this paper, we describe different hard and soft engineering techniques to overcome flood situations in these zones as these zones are more vulnerable due to lack of management in canal and river water. Effective management and use of hard and soft techniques are need of time in coming future for controlling greater flooding in flood risk zones to overcome or minimize people’s death as well as agricultural and financial resources as flood and other natural disasters are a major drawback in the economic prosperity of the country.

Keywords: flood management, rivers, major dams, agricultural and financial loss, future management and control

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Authors: Isabella Lima Leite de Freitas

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The importance of astronomy for humanity is unquestionable. Despite being a robust science, capable of bringing new discoveries every day and quickly increasing the ability of researchers to understand the universe more deeply, scientific research in this area can also help in various applications outside the domain of astronomy. The objective of this study was to review and conduct a descriptive analysis of published studies that presented the importance of astronomy in the area of education. A narrative review of the literature has been performed, considering the articles published in the last five years. As astronomy involves the study of physics, chemistry, biology, mathematics and technology, one of the studies evaluated presented astronomy as the gateway to science, demonstrating the presence of astronomy in 52 school curricula in 37 countries, with celestial movement the dominant content area. Another intervention study, evaluating individuals aged 4-5 years, demonstrated that the attribution of personal characteristics to cosmic bodies, in addition to the use of comprehensive astronomy concepts, favored the learning of science in preschool-age children, considering the use of practical activities of accompaniment and free drawing. Aiming to measure scientific literacy, another study developed in Turkey, motivated the authorities of this country to change the teaching materials and curriculum of secondary schools after the term “astronomy” appeared as one of the most attractive subjects for young people aged 15 to 24. There are also reports in the literature of the use of pedagogical tools, such as the representation of the Solar System on a human scale, where students can walk along the orbits of the planets while studying the laws of dynamics. The use of this tool favored the teaching of the relationship between distance, duration and speed over the period of the planets, in addition to improving the motivation and well-being of students aged 14-16. An important impact of astronomy on education was demonstrated in the study that evaluated the participation of high school students in the Astronomical Olympiads and the International Astronomy Olympiad. The study concluded that these Olympics have considerable influence on students who pursue a career in teaching or research later on, many of whom are in the area of astronomy itself. In addition, the literature indicates that the teaching of astronomy in the digital age has facilitated the availability of data for researchers, but also for the general population. This fact can increase even more the curiosity that the astronomy area has always instilled in people and promote the dissemination of knowledge on an expanded scale. Currently, astronomy has been considered an important ally in strengthening the school curricula of children, adolescents and young adults. This has been used as teaching tools, in addition to being extremely useful for scientific literacy, being increasingly used in the area of education.

Keywords: astronomy, education area, teaching, review

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Authors: Achirawatt Tungsombatsanti, Toansakul Santiboon, Kamon Ponkham

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Strategies of the STEM education was aimed to prepare of an interdisciplinary and applied approach for the instructional of science, technology, engineering, and mathematics in an integrated students for enhancing engagement of their science skills to the Problem-Based Learning (PBL) method in Borabu School with a sample consists of 80 students in 2 classes at the 12th grade level of their learning achievements on electromagnetic issue. Research administrations were to separate on two different instructional model groups, the 40-experimental group was designed with the STEM instructional experimenting preparation and induction in a 40-student class and the controlling group using the PBL was designed to students identify what they already know, what they need to know, and how and where to access new information that may lead to the resolution of the problem in other class. The learning environment perceptions were obtained using the 35-item Physics Laboratory Environment Inventory (PLEI). Students’ creating attitude skills’ sustainable development toward physics were assessed with the Test Of Physics-Related Attitude (TOPRA) The term scaling was applied to the attempts to measure the attitude objectively with the TOPRA was used to assess students’ perceptions of their science attitude toward physics. Comparisons between pretest and posttest techniques were assessed students’ learning achievements on each their outcomes from each instructional model, differently. The results of these findings revealed that the efficiency of the PLB and the STEM based on criteria indicate that are higher than the standard level of the 80/80. Statistically, significant of students’ learning achievements to their later outcomes on the controlling and experimental physics class groups with the PLB and the STEM instructional designs were differentiated between groups at the .05 level, evidently. Comparisons between the averages mean scores of students’ responses to their instructional activities in the STEM education method are higher than the average mean scores of the PLB model. Associations between students’ perceptions of their physics classes to their attitudes toward physics, the predictive efficiency R2 values indicate that 77%, and 83% of the variances in students’ attitudes for the PLEI and the TOPRA in physics environment classes were attributable to their perceptions of their physics PLB and the STEM instructional design classes, consequently. An important of these findings was contributed to student understanding of scientific concepts, attitudes, and skills as evidence with STEM instructional ought to higher responding than PBL educational teaching. Statistically significant between students’ learning achievements were differentiated of pre and post assessments which overall on two instructional models.

Keywords: learning instructional managements, problem-based learning, STEM education, method, enhancement, students learning achievements, science attitude, physics classes

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Authors: J. Lamilla-Monje, C. Solano-Puerto, L. Franco-Lara

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Trees play an essential role in cities due to their ability to provide multiple ecosystem goods and services. Bogota trees are threatened by factors such as pests, pathogens, contamination, among others. Among the pathogens, phytoplasmas are a potential risk for urban trees, generating symptoms that affect the ecosystem services that these trees provide in Bogota, an example of this is the affectation of Q. humboldtii by phytoplasmas, these bacteria are transmitted for insects of the order Hemiptera, this is why the objective of this work was to know if the climatic variables (humidity, precipitation, and temperature) and environmental variables (PM10 and PM2.5) could be related to the distribution of the Oak Quercus entomofauna and specifically with the phytoplasma vector insects in Bogota. For this study, the sampling points were distributed in areas of the city with contrasting variables in two types of locations: parks and streets. A total of 68 trees were sampled in which the associated insects were collected using two methodologies: jameo and agitation traps. The results show that insects of the order Hemiptera were the most abundant, including a total of 1682 individuals represented by 29 morphotypes, within this order individuals from eight families were collected (Aphidae, Aradidae, Berytidae, Cicadellidae, Issidae, Membracidae, Miridae, and Psyllidae), finding as possible vectors the families Cicadellidae, Membracidae, and Psyllidae with 959, 8 and 14 individuals respectively. Within the Cicadellidae family, 21 morphotypes were found, being reported as vectors in the literature: Amplicephalus, Exitianus atratus, Haldorus sp., Xestocephalus desertorum, Idiocerinae sp., Scaphytopius sp., the Membracidae family was represented by two morphotypes and the Psyllidae by one. Results that suggest that there is no correlation between climatic and environmental variables with the diversity of insects associated with oak. Knowing the vector insects of phytoplasmas in oak trees will complete the pathosystem and generate effective vector control.

Keywords: vector insects, diversity, phytoplasmas, Cicadellidae

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Authors: Aman Ullah Khan, Muhammad Younus, Aqil Ijaz, Muti-Ur-Rehman Khan, Sayyed Aun Muhammad, Asif Idrees, Sanan Raza, Amar Nasir

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Dengue fever and malaria are important vector-borne diseases of public health significance affecting millions of people around the globe. Dengue fever is caused by Dengue virus while malaria is caused by plasmodium protozoan. Generally, the consequences of Malaria are less severe compared to dengue fever. This study was designed to differentiate dengue fever and malaria on the basis of clinical and laboratory findings and to compare the changes in both diseases having different causative agents transmitted by the common vector. A total of 200 patients of dengue viral infection (120 males, 80 females) were included in this prospective descriptive study. The blood samples of the individuals were first screened for malaria by blood smear examination and then the negative samples were tested by anti-dengue IgM strip. The strip positive cases were further screened by IgM capture ELISA and their complete blood count including hemoglobin estimation (Hb), total and differential leukocyte counts (TLC and DLC), erythrocyte sedimentation rate (ESR) and platelet counts were performed. On the basis of the severity of signs and symptoms, dengue virus infected patients were subdivided into dengue fever (DF) and dengue hemorrhagic fever (DHF) comprising 70 and 100 confirmed patients, respectively. On the other hand, 30 patients were found infected with Malaria while overall 120 patients showed thrombocytopenia. The patients of DHF were found to have more leucopenia, raised hemoglobin level and thrombocytopenia < 50,000/µl compared to the patients belonging to DF and malaria. On the basis of the outcomes of the study, it was concluded that patients affected by DF were at a lower risk of undergoing haematological disturbance than suffering from DHF. While, the patients infected by Malaria were found to have no significant change in their blood components.

Keywords: dengue fever, blood, serum, malaria, ELISA

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Authors: Virakti Dhaval Shah

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Advances in technology and the changes in lifestyle and work expectations amid the COVID-19 pandemic are requiring changes to vocational assessment, provision of vocational training, and identification of job matches for individuals with intellectual disability. Vocational assessment involves the assessment of interests, skills, abilities, and strengths/weaknesses, as well as a detailed understanding of healthcare, familial, social, community, workplace-related and policy-level protective and risk factors impacting the individual. In India, vocational assessment procedures such as interviews play a major role in vocational placement today. Unfortunately, many of the most widely used vocational assessment instruments in India were developed in the 1970s to 2000s and have not been revised since. Hence, there is a dire need to update existing tools and prepare a structured approach for vocational service providers to meet the unique employment needs of individuals with intellectual disabilities. To address this need, this project designed a multi-domain assessment toolkit for a structured approach to vocational assessment, training, and job placement for individuals with intellectual disabilities in India. Methods included conducting an empirical review of the available tools currently in use in India for the vocational assessment of persons with intellectual disabilities. Domains addressed in the instrument review were organized into a structured system, and additional items related to contemporary technology, pandemic-related experiences of persons with disabilities, and changes in lifestyle and work expectations due to the pandemic were added. Items assessing behaviors, provision of vocational training, and identification of job matches for individuals with intellectual disabilities were developed. The proposed tool has the potential to benefit organizations working with and preparing individuals with intellectual disabilities to find successful employment by undertaking a structured approach to vocational assessment, rehabilitation, training, and placement. It can be particularly useful for guiding new professionals doing vocational rehabilitation in India.

Keywords: intellectual disability, rehabilitation, vocational assessment, vocational rehabilitation

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Authors: Gustavo Naranjo Maroto, Dolores Fernandez Martinez

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Context has always been essential to understand any reaction from every human being, and words, whether written or spoken, are definitely a powerful representative sample of human reaction. This study starts with an accurate breakdown of the context in which the current president of the US, Mr. Donald J. Trump is conveying his discourses in order to be able to judge them from a critical discourse analysis point of view. The present world’s scenario with a pandemic disease in form of Covid-19 that is threatening the world and certainly putting at risk the so called 'Welfare State', the role of the United States as the first superpower on earth nowadays, the very peculiar profile of President Trump not only as a politician but as a persona, and the fact of being on the verge of a very controversial presidential elections are without doubt a great and undeniable opportunity for the implementation of the critical discourse analysis methodology. Hence, this research will primarily analyze in detail some of the most interesting discourses delivered by Trump in different media since the very beginning of the outbreak of the coronavirus pandemic in the United States of America (February, 2020), sadly very often downplayed by President Trump, until the final result of the upcoming presidential election scheduled for Tuesday, November 3, 2020, where the political discourse has been dramatically downgraded to a very dangerous state, putting in jeopardy the fundamentals of the political fair play in terms of speech. Finally, the study will hopefully conclude with the final outcome of the data analyzed, allowing to picture how significant the context can be concerning linguistics on the one hand, in terms of shaping or altering the message that the issuer thought to convey in the first place, and on the other hand, generously assessing to what extend the recipients of the message are influenced by the message in terms of receptiveness.

Keywords: Covid-19, critical discourse analysis, Donald J. Trump, political discourse

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Authors: Dorit Alt, Nirit Raichel

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Although university teaching is claimed to have a special task to support students in adopting ways of thinking and producing new knowledge anchored in scientific inquiry practices, it is argued that students' habits of learning are still overwhelmingly skewed toward passive acquisition of knowledge from authority sources rather than from collaborative inquiry activities.This form of instruction is criticized for encouraging students to acquire inert knowledge that can be used in instructional settings at best, however cannot be transferred into real-life complex problem settings. In order to overcome this critical inadequacy between current educational goals and instructional methods, the LLAF consortium (including 16 members from 8 countries) is aimed at developing updated instructional practices that put a premium on adaptability to the emerging requirements of present society. LLAF has created a practical guide for teachers containing updated pedagogical strategies and assessment tools, based on the constructivist approach for learning that put a premium on adaptability to the emerging requirements of present society. This presentation will be limited to teachers' education only and to the contribution of the project in providing a scale designed to measure the extent to which the constructivist activities are efficiently applied in the learning environment. A mix-method approach was implemented in two phases to construct the scale: The first phase included a qualitative content analysis involving both deductive and inductive category applications of students' observations. The results foregrounded eight categories: knowledge construction, authenticity, multiple perspectives, prior knowledge, in-depth learning, teacher- student interaction, social interaction and cooperative dialogue. The students' descriptions of their classes were formulated as 36 items. The second phase employed structural equation modeling (SEM). The scale was submitted to 597 undergraduate students. The goodness of fit of the data to the structural model yielded sufficient fit results. This research elaborates the body of literature by adding a category of in-depth learning which emerged from the content analysis. Moreover, the theoretical category of social activity has been extended to include two distinctive factors: cooperative dialogue and social interaction. Implications of these findings for the LLAF project are discussed.

Keywords: constructivist learning, higher education, mix-methodology, structural equation modeling

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Authors: Ahmed Shaboub, Yusuf Jasim Althawadi, Shadi Alaa Abdelaal, Mohamed Hussein Abdalla, Hatem Amr Elzahaby, Mohamed Mohamed, Hazem S. Ghaith, Ahmed Negida

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Objectives: We aimed to compare the safety and outcomes of the minimally invasive approaches versus conventional sternotomy procedures for aortic valve replacement. Methods: We conducted a PRISMA-compliant systematic review and meta-analysis. We ran an electronic search of PubMed, Cochrane CENTRAL, Scopus, and Web of Science to identify the relevant published studies. Data were extracted and pooled as standardized mean difference (SMD) or risk ratio (RR) using StataMP version 17 for macOS. Results: Forty-one studies with a total of 15,065 patients were included in this meta-analysis (minimally invasive approaches n=7231 vs. conventional sternotomy n=7834). The pooled effect size showed that minimally invasive approaches had lower mortality rate (RR 0.76, 95%CI [0.59 to 0.99]), intensive care unit and hospital stays (SMD -0.16 and -0.31, respectively), ventilation time (SMD -0.26, 95%CI [-0.38 to -0.15]), 24-h chest tube drainage (SMD -1.03, 95%CI [-1.53 to -0.53]), RBCs transfusion (RR 0.81, 95%CI [0.70 to 0.93]), wound infection (RR 0.66, 95%CI [0.47 to 0.92]) and acute renal failure (RR 0.65, 95%CI [0.46 to 0.93]). However, minimally invasive approaches had longer operative time, cross-clamp, and bypass times (SMD 0.47, 95%CI [0.22 to 0.72], SMD 0.27, 95%CI [0.07 to 0.48], and SMD 0.37, 95%CI [0.20 to 0.45], respectively). There were no differences between the two groups in blood loss, endocarditis, cardiac tamponade, stroke, arrhythmias, pneumonia, pneumothorax, bleeding reoperation, tracheostomy, hemodialysis, or myocardial infarction (all P>0.05). Conclusion: Current evidence showed higher safety and better operative outcomes with minimally invasive aortic valve replacement compared to the conventional approach. Future RCTs with long-term follow-ups are recommended.

Keywords: aortic replacement, minimally invasive, sternotomy, mini-sternotomy, aortic valve, meta analysis

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Authors: Ana L. Gonzalez-Celis, Edgardo Ruiz-Carrillo, Karina Reyes-Jarquin, Margarita Chavez-Becerra

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Since recent decades, the aging has been viewed from a more positive perspective, where is not only about losses and damage, but also about being on a stage where you can enjoy life and live with well-being and quality of life. The challenge to feel better is to find those resources that seniors have. For that reason, psychological well-being has shown interest in the study of the affect and life satisfaction (hedonic well-being), while from a more recent tradition, focus on the development of capabilities and the personal growth, considering both as the main indicators of the quality of life. A resource that can be used in the later age is generativity, which refers to the ability of older people to develop and grow through activities that contribute with the improvement of the context in which they live and participate. In this way the generative interest is understood as a favourable attitude that contribute to the common benefit while strengthening and enriching the social institutions, to ensure continuity between generations and social development. On the other hand, generative behavior, differentiating from generative interest, is the expression of that attitude reflected in activities that make a social contribution and a benefit for generations to come. Hence the purpose of the research was to test if there is an association between the generative behaviour type and the psychological well-being with their dimensions. For this reason 188 Mexican adults from 60 to 94 years old (M = 69.78), 67% women, 33% men, completed two instruments: The Ryff’s Well-Being Scales to measure psychological well-being with 39 items with two dimensions (Hedonic and Eudaimonic well-being), and the Loyola’s Generative Behaviors Scale, grouped in five categories: Knowledge transmitted to the next generation, things to be remember, creativity, be productive, contribution to the community, and responsibility of other people. In addition, the socio-demographic data sheet was tested, and self-reported health status. The results indicated that the psychological well-being and its dimensions were significantly associated with the presence of generative behavior, where the level of well-being was higher when the frequency of some generative behaviour excelled; finding that the behavior with greater psychological well-being (M = 81.04, SD = 8.18) was "things to be remembered"; while with greater hedonic well-being (M = 73.39, SD = 12.19) was the behavior "responsibility of other people"; and with greater Eudaimonic well-being (M = 84.61, SD = 6.63), was the behavior "things to be remembered”. The most important findings highlight the importance of generative behaviors in adulthood, finding empirical evidence that the generativity in the last stage of life is associated with well-being. However, by finding differences in the types of generative behaviors at the level of well-being, is proposed the idea that generativity is not situated as an isolated construct, but needs other contextualized and related constructs that can simultaneously operate at different levels, taking into account the relationship between the environment and the individual, encompassing both the social and psychological dimension.

Keywords: eudaimonic well-being, generativity, hedonic well-being, Mexican elders, psychological well-being

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Authors: A. Benedetto, P. Wong, N. Papouchis, L. W. Samstag

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Bowen’s concept of self-differentiation describes a healthy balance of autonomy and intimacy in close relationships, and it has been widely researched in the context of family dynamics. The current study aimed to clarify the impact of family dysfunction on self-differentiation by specifically examining conflict between parents, and by including young adults, an underexamined age group in this domain (N = 300; ages 18 to 30). It also identified a protective factor for offspring from conflictual homes. The 300 young adults (recruited online through Mechanical Turk) completed the Differentiation of Self Inventory (DSI), the Children’s Perception of Interparental Conflict Scale (CPIC), the Parental Bonding Instrument (PBI), and the Symptom Checklist-90-Revised (SCL-90-R). Analyses revealed that interparental conflict significantly impairs self-differentiation among young adult offspring. Specifically, exposure to parental conflict showed a negative impact on young adults’ sense of self, emotional reactivity, and interpersonal cutoff in the context of close relationships. Parental conflict was also related to increased psychological distress among offspring. Surprisingly, the study found that parental divorce does not impair self-differentiation in offspring, demonstrating the distinctly harmful impact of conflict. These results clarify a unique type of family dysfunction that impairs self-differentiation, specifically in distinguishing it from parental divorce; it examines young adults, a critical age group not previously examined in this domain; and it identifies a moderating protective factor (a strong parent-child bond) for offspring exposed to conflict. Overall, results suggest the need for modifications in parental behavior in order to protect offspring at risk of lasting emotional and interpersonal damage.

Keywords: divorce, family dysfunction, parental conflict, parent-child bond, relationships, self-differentiation, young adults

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Authors: Shivahari Revathi Venkateswaran

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Segmenting customers plays a significant role in churn prediction. It helps the marketing team with proactive and reactive customer retention. For the reactive retention, the retention team reaches out to customers who already showed intent to disconnect by giving some special offers. When coming to proactive retention, the marketing team uses churn prediction model, which ranks each customer from rank 1 to 100, where 1 being more risk to churn/disconnect (high ranks have high propensity to churn). The churn prediction model is built by using XGBoost model. However, with the churn rank, the marketing team can only reach out to the customers based on their individual ranks. To profile different groups of customers and to frame different marketing strategies for targeted groups of customers are not possible with the churn ranks. For this, the customers must be grouped in different segments based on their profiles, like demographics and other non-controllable attributes. This helps the marketing team to frame different offer groups for the targeted audience and prevent them from disconnecting (proactive retention). For segmentation, machine learning approaches like k-mean clustering will not form unique customer segments that have customers with same attributes. This paper finds an alternate approach to find all the combination of unique segments that can be formed from the user attributes and then finds the segments who have uplift (churn rate higher than the baseline churn rate). For this, search algorithms like fast search and recursive search are used. Further, for each segment, all customers can be targeted using individual churn ranks from the churn prediction model. Finally, a UI (User Interface) is developed for the marketing team to interactively search for the meaningful segments that are formed and target the right set of audience for future marketing campaigns and prevent them from disconnecting.

Keywords: churn prediction modeling, XGBoost model, uplift segments, proactive marketing, search algorithms, retention, k-mean clustering

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Authors: V. Suganya, V. Balasuriya

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The functioning of Micro and Small Scale (MSS) businesses in the northern part of Sri Lanka was vulnerable due to three decades of internal conflict and the subsequent post-war economic openings has resulted new market prospects for MSS businesses. MSS businesses survive and operate with limited resources and struggle to access finance, raw material, markets, and technology. This study attempts to identify the manner in which entrepreneurial orientation puts into practice by the business operators to overcome these business challenges. Business operators in the traditional food processing sector are taken for this study as this sub-sector of the food industry is developing at a rapid pace. A review of the literature was done to recognize the concepts of entrepreneurial orientation, defining MMS businesses and the manner in which business performance is measured. Direct interview method supported by a structured questionnaire is used to collect data from 80 respondents; based on a fixed interval random sampling technique. This study reveals that more than half of the business operators have opted to commence their business ventures as a result of identifying a market opportunity. 41 per cent of the business operators are highly entrepreneurial oriented in a scale of 1 to 5. Entrepreneurial orientation shows significant relationship and strongly correlated with business performance. Pro-activeness, innovativeness and competitive aggressiveness shows a significant relationship with business performance while risk taking is negative and autonomy is not significantly related to business performance. It is evident that entrepreneurial oriented business practices contribute to better business performance even though 70 per cent prefer the ideas/views of the support agencies than the stakeholders when making business decisions. It is recommended that appropriate training should be introduced to develop entrepreneurial skills focusing to improve business networks so that new business opportunities and innovative business practices are identified.

Keywords: Micro and Small Scale (MMS) businesses, entrepreneurial orientation (EO), food processing, business operators

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Authors: Caren Hilger, Silke Burkert, Friederike Kendel

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Men with localized prostate cancer (PCa) have to choose among different treatment options, such as active surveillance (AS) and radical prostatectomy (RP). All available treatment options may be accompanied by specific psychological or physiological side effects. Depending on the nature and extent of these side effects, patients are more or less likely to be satisfied or to struggle with their treatment decision in the long term. Therefore, the aim of this study was to assess and explain decisional regret in men with localized PCa. The role of erectile functioning as one of the main physiological side effects of invasive PCa treatment, depressive symptoms as a common psychological side effect, and the association of erectile functioning and depressive symptoms with decisional regret were investigated. Men with localized PCa initially managed with AS or RP (N=292) were matched according to length of therapy (mean 47.9±15.4 months). Subjects completed mailed questionnaires assessing decisional regret, changes in erectile functioning, depressive symptoms, and sociodemographic variables. Clinical data were obtained from case report forms. Differences among the two treatment groups (AS and RP) were calculated using t-tests and χ²-tests, relationships of decisional regret with erectile functioning and depressive symptoms were computed using multiple regression. Men were on average 70±7.2 years old. The two treatment groups differed markedly regarding decisional regret (p<.001, d=.50), changes in erectile functioning (p<.001, d=1.2), and depressive symptoms (p=.01, d=.30), with men after RP reporting higher values, respectively. Regression analyses showed that after adjustment for age, tumor risk category, and changes in erectile functioning, depressive symptoms were still significantly associated with decisional regret (B=0.52, p<.001). Additionally, when predicting decisional regret, the interaction of changes in erectile functioning and depressive symptoms reached significance for men after RP (B=0.52, p<.001), but not for men under AS (B=-0.16, p=.14). With increased changes in erectile functioning, the association of depressive symptoms with decisional regret became stronger in men after RP. Decisional regret is a phenomenon more prominent in men after RP than in men under AS. Erectile functioning and depressive symptoms interact in their prediction of decisional regret. Screening and treating depressive symptoms might constitute a starting point for interventions aiming to reduce decisional regret in this target group.

Keywords: active surveillance, decisional regret, depressive symptoms, erectile functioning, prostate cancer, radical prostatectomy

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Authors: M. Aboalazayem, Essam A. Gouda, Ahmed M. Moussa, Amr E. Flifl

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Field data collecting is considered one of the most difficult work due to the difficulty of accessing large zones such as large lakes. Also, it is well known that the cost of obtaining field data is very expensive. Remotely monitoring of lake water quality (WQ) provides an economically feasible approach comparing to field data collection. Researchers have shown that lake WQ can be properly monitored via Remote sensing (RS) analyses. Using satellite images as a method of WQ detection provides a realistic technique to measure quality parameters across huge areas. Landsat (LS) data provides full free access to often occurring and repeating satellite photos. This enables researchers to undertake large-scale temporal comparisons of parameters related to lake WQ. Satellite measurements have been extensively utilized to develop algorithms for predicting critical water quality parameters (WQPs). The goal of this paper is to use RS to derive WQ indicators in Aswan High Dam Reservoir (AHDR), which is considered Egypt's primary and strategic reservoir of freshwater. This study focuses on using Landsat8 (L-8) band surface reflectance (SR) observations to predict water-quality characteristics which are limited to Turbidity (TUR), total suspended solids (TSS), and chlorophyll-a (Chl-a). ArcGIS pro is used to retrieve L-8 SR data for the study region. Multiple linear regression analysis was used to derive new correlations between observed optical water-quality indicators in April and L-8 SR which were atmospherically corrected by values of various bands, band ratios, and or combinations. Field measurements taken in the month of May were used to validate WQP obtained from SR data of L-8 Operational Land Imager (OLI) satellite. The findings demonstrate a strong correlation between indicators of WQ and L-8 .For TUR, the best validation correlation with OLI SR bands blue, green, and red, were derived with high values of Coefficient of correlation (R2) and Root Mean Square Error (RMSE) equal 0.96 and 3.1 NTU, respectively. For TSS, Two equations were strongly correlated and verified with band ratios and combinations. A logarithm of the ratio of blue and green SR was determined to be the best performing model with values of R2 and RMSE equal to 0.9861 and 1.84 mg/l, respectively. For Chl-a, eight methods were presented for calculating its value within the study area. A mix of blue, red, shortwave infrared 1(SWR1) and panchromatic SR yielded the greatest validation results with values of R2 and RMSE equal 0.98 and 1.4 mg/l, respectively.

Keywords: remote sensing, landsat 8, nasser lake, water quality

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Authors: Maria I. Nuñez-Hernández, Maria L. Riesco

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Background: Exclusive breastfeeding (EBF) up to 6 months old infant have been considered one of the most important factors in the overall development of children. Nevertheless, as resources are scarce, it is essential to identify the most vulnerable groups that have major risk of EBF abandonment, in order to deliver the best strategies. Children of adolescent mothers are within these groups. Aims: To determine the EBF abandonment rate among adolescent mothers and to analyze the associated factors. Methods: Prospective cohort study of adolescent mothers in the southern area of Santiago, Chile, conducted in primary care services of public health system. The cohort was established from 2014 to 2015, with a sample of 105 adolescent mothers and their children at 2 months of life. The inclusion criteria were: adolescent mother from 14 to 19 years old; not twin babies; mother and baby leaving the hospital together after birthchild; correct attachment of the baby to the breast; no difficulty understanding the Spanish language or communicating. Follow-up was performed at 4 and 6 months old infant. Data were collected by interviews, considering EBF as breastfeeding only, without adding other milk, tea, juice, water or other product that not breast milk, except drugs. Data were analyzed by descriptive and inferential statistics, by Kaplan-Meier estimator and Log-Rank test, admitting the probability of occurrence of type I error of 5% (p-value = 0.05). Results: The cumulative EBF abandonment rate at 2, 4 and 6 months was 33.3%, 52.2% and 63.8%, respectively. Factors associated with EBF abandonment were maternal perception of the quality of milk as poor (p < 0.001), maternal perception that the child was not satisfied after breastfeeding (p < 0.001), use of pacifier (p < 0.001), maternal consumption of illicit drugs after delivery (p < 0.001), mother return to school (p = 0.040) and presence of nipple trauma (p = 0.045). Conclusion: EBF abandonment rate was higher in the first 4 months of life and is superior to the population of women who breastfeed. Among the EBF abandonment factors, one of them is related to the adolescent condition, and two are related to the maternal subjective perception.

Keywords: adolescent, breastfeeding, midwifery, nursing

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Authors: Nejla Fourati, Zied Fessi, Fatma Dhouib, Wicem Siala, Leila Farhat, Afef Khanfir, Wafa Mnejja, Jamel Daoud

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Purpose: Radiation induced hypothyroidism in nasopharyngeal cancer (NPC) ranged from 15% to 55%. In reported data, it is considered as a common late complication of definitive radiation and is mainly observed 2 years after the end of treatment. The aim of this study was to evaluate the incidence of early hypothyroidism within 6 months after radiotherapy. Patients and methods: From June 2017 to February 2020, 35 patients treated with concurrent chemo-radiotherapy (CCR) for NPC were included in this prospective study. Median age was 49 years [23-68] with a sex ratio of 2.88. All patients received intensity modulated radiotherapy (IMRT) at a dose of 69.96 Gy in 33 daily fractions with weekly cisplatin (40mg/m²) chemotherapy. Thyroid stimulating hormone (TSH) and Free Thyroxine 4 (FT4) dosage was performed before the start of radiotherapy and 6 months after. Different dosimetric parameters for the thyroid gland were reported: the volume (cc); the mean dose (Dmean) and the %age of volume receiving more than 45 Gy (V45Gy). Wilcoxon Test was used to compare these different parameters between patients with or without hypothyroidism. Results: At baseline, 5 patients (14.3%) had hypothyroidism and were excluded from the analysis. For the remaining 30 patients, 9 patients (30%) developed a hypothyroidism 6 months after the end of radiotherapy. The median thyroid volume was 10.3 cc [4.6-23]. The median Dmean and V45Gy were 48.3 Gy [43.15-55.4] and 74.8 [38.2-97.9] respectively. No significant difference was noted for all studied parameters. Conclusion: Early hypothyroidism occurring within 6 months after CCR for NPC seems to be a common complication (30%) that should be screened. Good patient monitoring with regular dosage of TSH and FT4 makes it possible to treat hypothyroidism in asymptomatic phase. This would be correlated with an improvement in the quality of life of these patients. The results of our study do not show a correlation between the thyroid doses and the occurrence of hypothyroidism. This is probably related to the high doses received by the thyroid in our series. These findings encourage more optimization to limit thyroid doses and then the risk of radiation-induced hypothyroidism

Keywords: nasopharyngeal carcinoma, hypothyroidism, early complication, thyroid dose

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Authors: Sayantan Khanra, Rojers P. Joseph

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Background and Significance: This study is aimed at analyzing the role of demographic and service quality variables in the adoption and diffusion of e-government services among the users in India. The study proposes to examine the users' perception about e-Government services and investigate the key variables that are most salient to the Indian populace. Description of the Basic Methodologies: The methodology to be adopted in this study is Hierarchical Regression Analysis, which will help in exploring the impact of the demographic variables and the quality dimensions on the willingness to use e-government services in two steps. First, the impact of demographic variables on the willingness to use e-government services is to be examined. In the second step, quality dimensions would be used as inputs to the model for explaining variance in excess of prior contribution by the demographic variables. Present Status: Our study is in the data collection stage in collaboration with a highly reliable, authentic and adequate source of user data. Assuming that the population of the study comprises all the Internet users in India, a massive sample size of more than 10,000 random respondents is being approached. Data is being collected using an online survey questionnaire. A pilot survey has already been carried out to refine the questionnaire with inputs from an expert in management information systems and a small group of users of e-government services in India. The first three questions in the survey pertain to the Internet usage pattern of a respondent and probe whether the person has used e-government services. If the respondent confirms that he/she has used e-government services, then an aggregate of 15 indicators are used to measure the quality dimensions under consideration and the willingness of the respondent to use e-government services, on a five-point Likert scale. If the respondent reports that he/she has not used e-government services, then a few optional questions are asked to understand the reason(s) behind the same. Last four questions in the survey are dedicated to collect data related to the demographic variables. An indication of the Major Findings: Based on the extensive literature review carried out to develop several propositions; a research model is prescribed to start with. A major outcome expected at the completion of the study is the development of a research model that would help to understand the relationship involving the demographic variables and service quality dimensions, and the willingness to adopt e-government services, particularly in an emerging economy like India. Concluding Statement: Governments of emerging economies and other relevant agencies can use the findings from the study in designing, updating, and promoting e-government services to enhance public participation, which in turn, would help to improve efficiency, convenience, engagement, and transparency in implementing these services.

Keywords: adoption and diffusion of e-government services, demographic variables, hierarchical regression analysis, service quality dimensions

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Authors: Shahnaz Haque, Anand Shukla, Sunita Singh, Anil Kem

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Introduction: Diabetes Mellitus is a chronic metabolic disease affecting millions worldwide. Metformin is the most commonly prescribed first line oral hypoglycemic drug for type 2 diabetes mellitus, but due to progressive worsening of blood glucose control during the natural history of type 2 diabetes, combination therapy usually becomes necessary. Objective: This study was designed to assess the treatment satisfaction between Sitagliptin versus Pioglitazone added to Metformin in patients with type 2 diabetes mellitus (T2DM). Methods: We conducted a prospective, open label, randomized, parallel group study in SIMS, Hapur, U.P. Eligible patients fulfilling inclusion criteria were randomized into two groups having 25 patients in each group using tab Sitagliptin 100mg, tab Pioglitazone 30mg added to ongoing tab Metformin (500mg) therapy for 16 weeks. The follow-up visits were on weeks 4,12 and 16. Result: 16 weeks later, addition of Sitagliptin 100mg compared to that of Pioglitazone 30 mg to ongoing Metformin therapy provided similar glycosylated hemoglobin (HbA1c) lowering efficacy in patients with T2DM with inadequate glycemic control on metformin monotherapy. Change in HbA1c in group1 was -0.656±0.21%(p<0.0001) whereas in group2 was -0.748±0.35%(p<0.0001). Hence decrease in HbA1c from baseline was more in group2. Both treatments were well tolerated with negligible risk of hypoglycaemia. Weight loss was observed with Sitagliptin in contrast to weight gain seen in Pioglitazone. Conclusion: In this study, Sitagliptin 100 mg along with metformin therapy in comparison to pioglitazone 30 mg plus metformin therapy was both effective, well-tolerated and improved glycemic control in both the groups. Addition of pioglitazone had cause oedema and weight gain to the patients whereas sitagliptin caused weight loss in its patients.

Keywords: sitagliptin, pioglitazone, metformin, type 2 diabetes mellitus

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Authors: Emily C. Shepard, Caroline Sweeney, Jessica Grimm, Sophie Jacobs, Lauren Thompson, Lisa L. Weyandt

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Adolescence is a critical phase of development in which individuals are prone to more risky behavior while also facing potentially life-changing decisions. The balance of increased behavioral risk and responsibility indicates the importance of executive functioning ability. In recent years, executive function training has emerged as a technique to enhance this cognitive ability. The aim of the present systematic review was to discuss the reported efficacy of executive functioning training techniques among adolescents. After reviewing 3110 articles, a total of 24 articles were identified which examined the role of executive functioning training techniques among adolescents (age 10-19). Articles retrieved demonstrated points of comparison across psychiatric and medical diagnosis, location of training, and stage of adolescence. Typically developing samples, as well as those with attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), conduct disorder, and physical health concerns were found, allowing for the comparison of the efficacy of techniques considering physical and psychological heterogeneity. Among typically developing adolescents, executive functioning training yielded nonsignificant or low effect size improvements in executive functioning, and in some cases executive functioning ability was decreased following the training. In special populations, including those with ADHD, (ASD), conduct disorder, and physical health concerns significant differences and larger effect sizes in executive functioning were seen following treatment, particularly among individuals with ADHD. Future research is needed to identify the long-term efficacy of these treatments, as well as their generalizability to real-world conditions.

Keywords: adolescence, attention-deficit hyperactivity disorder, executive function, executive function training, traumatic brain injury

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Authors: Madhat Abu Al-Naeem, Ismail Yusoff, Ng Tham Fatt, Yatimah Alias

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Groundwater in Gaza strip is increasingly being exposed to anthropic and natural factors that seriously impacted the groundwater quality. Physiochemical data of groundwater can offer important information on changes in groundwater quality that can be useful in improving water management tactics. An integrative hydrochemical and statistical techniques (Hierarchical cluster analysis (HCA) and factor analysis (FA)) have been applied on the existence ten physiochemical data of 84 samples collected in (2000/2001) using STATA, AquaChem, and Surfer softwares to: 1) Provide valuable insight into the salinization sources and the hydrochemical processes controlling the chemistry of groundwater. 2) Differentiate the influence of natural processes and man-made activities. The recorded large diversity in water facies with dominance Na-Cl type that reveals a highly saline aquifer impacted by multiple complex hydrochemical processes. Based on WHO standards, only (15.5%) of the wells were suitable for drinking. HCA yielded three clusters. Cluster 1 is the highest in salinity, mainly due to the impact of Eocene saline water invasion mixed with human inputs. Cluster 2 is the lowest in salinity also due to Eocene saline water invasion but mixed with recent rainfall recharge and limited carbonate dissolution and nitrate pollution. Cluster 3 is similar in salinity to Cluster 2, but with a high diversity of facies due to the impact of many sources of salinity as sea water invasion, carbonate dissolution and human inputs. Factor analysis yielded two factors accounting for 88% of the total variance. Factor 1 (59%) is a salinization factor demonstrating the mixing contribution of natural saline water with human inputs. Factor 2 measure the hardness and pollution which explained 29% of the total variance. The negative relationship between the NO3- and pH may reveal a denitrification process in a heavy polluted aquifer recharged by a limited oxygenated rainfall. Multivariate statistical analysis combined with hydrochemical analysis indicate that the main factors controlling groundwater chemistry were Eocene saline invasion, seawater invasion, sewage invasion and rainfall recharge and the main hydrochemical processes were base ion and reverse ion exchange processes with clay minerals (water rock interactions), nitrification, carbonate dissolution and a limited denitrification process.

Keywords: dendrogram and cluster analysis, water facies, Eocene saline invasion and sea water invasion, nitrification and denitrification

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Authors: Babulayi B. Wilson

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Unsatisfactory performance of construction projects in both the industrialised and developing countries indicate that there could be several defects in construction projects phases. Notwithstanding the fact that some project defects are often conceived at the initiation phase of construction projects, insufficient knowledge of contract procedures has been identified as one of the major sources of construction disputes. Contract procedures are a set of rules that outlines the primary obligations and liabilities of parties involved in the implementation of a construction project. Engineering professional bodies often codify contract procedures into standard forms of contract such as the Institution of Civil Engineers (ICE, UK) and Association of Consulting Engineers (ACE, UK) and keep them under constant review by updating any clause to reflect any change in case law or relevant piece of legislation. Even so, it is the responsibility of a professional body or conditions of contract draftsperson to introduce contract-specific clauses that may be necessary for business efficacy but not covered in the chosen standard conditions of contract. In Botswana, the use of clients’ drafted and/or un-adapted for environment of use international forms of contract in conjunction with client-drafted pricing schedules is common. The product of the latter often impact negatively upon contractors’ claims and payments, in that, tender rates and prices can only be deemed to be sufficient if the chosen conditions of contract compliment the pricing schedule (use of standardised procurement documents). In addition, client drafted and the use of borrowed forms of contract such as FIDIC often conflict with domicile law resulting in costly disputes on the part of the client. It is upon the preceding text that the object of the research is to measure the level of knowledge of contract procedures amongst key stakeholders in the Botswana construction industry by requesting a representative sample from the industry and academia to respond to tutorial questions prepared from two commonly used forms of contract for civil works, that is, FIDIC (International Form of Contract) and ICE (UK). The questions were prepared under the following captions: (a) preparation of tender documents (b) obligations of the parties (c) contract administration; and (d) claims, variations, and valuation of variations. After ascertaining that the level of knowledge of contract procedures is insufficient among most practitioners in the Botswana construction industry, major procurement entities, and engineering institutions of learning; a guide to drafting a condition of a construction contract was developed and then validated through seminars and workshops. In the present, the effectiveness of the guide is not yet measured but feedback from seminars and workshops conducted indicates an appreciation of the guide by the majority of major construction industry stakeholders.

Keywords: contract procedures, conditions of contract, professional practice, construction law, forms of contract

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Authors: Xin Li, Yan-Rong Guo, Jin-Fang Lin, Yi Feng, Håkan Billig, Ruijin Shao

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Background: Young women with polycystic ovary syndrome (PCOS) have a high risk of developing endometrial carcinoma. There is a need for the development of new medical therapies that can reduce the need for surgical intervention so as to preserve the fertility of these patients. The aim of the study was to describe and discuss cases of PCOS and insulin resistance (IR) women with early endometrial carcinoma while being co-treated with Diane-35 and metformin. Methods: Five PCOS-IR women who were scheduled for diagnosis and therapy for early endometrial carcinoma were recruited. The hospital records and endometrial pathology reports were reviewed. All patients were co-treated with Diane-35 and metformin for 6 months to reverse the endometrial carcinoma and preserve their fertility. Before, during, and after treatment, endometrial biopsies and blood samples were obtained and oral glucose tolerance tests were performed. Endometrial pathology was evaluated. Body weight (BW), body mass index (BMI), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHBG), free androgen index (FAI), insulin area under curve (IAUC), and homeostasis model assessment of insulin resistance (HOMA-IR) were determined. Results: Clinical stage 1a, low grade endometrial carcinoma was confirmed before treatment. After 6 months of co-treatment, all patients showed normal epithelia. No evidence of atypical hyperplasia or endometrial carcinoma was found. Co-treatment resulted in significant decreases in BW, BMI, TT, FAI, IAUC, and HOMA-IR in parallel with a significant increase in SHBG. There were no differences in the FSH and LH levels after co-treatment. Conclusions: Combined treatment with Diane-35 and metformin has the potential to revert the endometrial carcinoma into normal endometrial cells in PCOS-IR women. The cellular and molecular mechanisms behind this effect merit further investigation.

Keywords: PCOS, progesterone resistance, insulin resistance, steroid hormone receptors, endometrial carcinoma

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Authors: E. N. Masri, E. Takács

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Amplitude Versus Offset (AVO) and simultaneous model-based impedance inversion techniques have not been utilized for geothermal exploration commonly; however, some recent publications called the attention that they can be very useful in the geothermal investigations. In this study, we present rock physical attributes obtained from 3D pre-stack seismic data and well logs collected in a study area of the NW part of Pannonian Basin where the geothermal reservoir is located in the fractured zones of Triassic basement and it was hit by three productive-injection well pairs. The holes were planned very successfully based on the conventional 3D migrated stack volume prior to this study. Subsequently, the available geophysical-geological datasets provided a great opportunity to test modern inversion procedures in the same area. In this presentation, we provide a summary of the theory and application of the most promising seismic inversion techniques from the viewpoint of geothermal exploration. We demonstrate P- and S-wave impedance, as well as the velocity (Vp and Vs), the density, and the Vp/Vs ratio attribute volumes calculated from the seismic and well-logging data sets. After a detailed discussion, we conclude that P-wave impedance and Vp/Vp ratio are the most helpful parameters for lithology discrimination in the study area. They detect the hot water saturated fracture zone very well thus they can be very useful in mapping the investigated reservoir. Integrated interpretation of all the obtained rock-physical parameters is essential. We are extending the above discussed pre-stack seismic tools by studying the possibilities of Elastic Impedance Inversion (EII) for geothermal exploration. That procedure provides two other useful rock-physical properties, the compressibility and the rigidity (Lamé parameters). Results of those newly created elastic parameters will also be demonstrated in the presentation. Geothermal extraction is of great interest nowadays; and we can adopt several methods have been successfully applied in the hydrocarbon exploration for decades to discover new reservoirs and reduce drilling risk and cost.

Keywords: fractured zone, seismic, well-logging, inversion

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Authors: Mahmoud T. Alwidyan, Ahmad Alrawashdeh, Alaa O. Oteir

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Background: Emergency medical service (EMS) providers, oftentimes, use the lights and sirens (L&S) of their ambulances to warn road users, navigate through traffic, and expedite transport to save lives of ill and injured patients. Despite the contribution of road users in the effectiveness of reducing transport time of EMS ambulances using L&S, there is a lack of empirical assessments exploring the road user’s attitude and behavior in such situations. This study, therefore, aimed to assess the attitude and behavior of road users in response to EMS ambulances with warning L&S in use. Methods: This was a cross-sectional survey developed and distributed to adult road users in Northern Jordan. The questionnaire included 20 items addressing demographics, attitudes, and behavior toward emergency ambulances. We described the participants’ responses and assessed the association between demographics and attitude statements using logistic regression. Results: A total of 1302 questionnaires were complete and appropriate for analysis. The mean age was 34.2 (SD± 11.4) years, and the majority were males (72.6%). About half of road users (47.9%) in our sample would perform inappropriate action in response to EMS ambulances with L&S in use. The multivariate logistic regression model show that being female (OR, 0.63; 95% CI = 0.48-0.81), more educated (OR, 0.68; 95% CI = 0.53-0.86), or public transport driver (OR, 0.55; 95% CI = 0.34-0.90) is significantly associated with inappropriate response to EMS ambulances. Additionally, a significant proportion of road users may perform inappropriate and lawless driving practices such as crossing red traffic lights or following the passing by EMS ambulances, which would, in turn, increase the risk on ambulances and other road users. Conclusions: A large proportion of road users in Jordan may respond inappropriately to the EMS ambulances, and many engage in risky driving behaviors due perhaps to the lack of procedural knowledge. Policy-related interventions and educational programs are crucially needed to increase public awareness of the traffic law concerning EMS ambulances and to enhance appropriate driving behavior, which, in turn, improves the efficiency of ambulance services.

Keywords: EMS ambulances, lights and sirens, road users, attitude and behavior

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Authors: Mrinal Kanti Bhowmik, Usha Rani Gogoi Jr., Anjan Kumar Ghosh, Debotosh Bhattacharjee

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In the last few decades, breast thermography has achieved an average sensitivity and specificity of 90% for breast tumor detection. Breast thermography is a non-invasive, cost-effective, painless and radiation-free breast imaging modality which makes a significant contribution to the evaluation and diagnosis of patients, suspected of having breast cancer. An abnormal breast thermogram may indicate significant biological risk for the existence or the development of breast tumors. Breast thermography can detect a breast tumor, when the tumor is in its early stage or when the tumor is in a dense breast. The infrared breast thermography is very sensitive to environmental changes for which acquisition of breast thermography should be performed under strictly controlled conditions by undergoing some standard protocols. Several factors like air, temperature, humidity, etc. are there to be considered for characterizing thermal images as an imperative tool for detecting breast cancer. A detailed study of various breast thermogram acquisition protocols adopted by different researchers in their research work is provided here in this paper. After going through a rigorous study of different breast thermogram acquisition protocols, a new standard breast thermography acquisition setup is proposed here in this paper for proper and accurate capturing of the breast thermograms. The proposed breast thermogram acquisition setup is being built in the Radiology Department, Agartala Government Medical College (AGMC), Govt. of Tripura, Tripura, India. The breast thermograms are captured using FLIR T650sc thermal camera with the thermal sensitivity of 20 mK at 30 degree C. The paper is an attempt to highlight the importance of different critical parameters of breast thermography like different thermography views, patient preparation protocols, acquisition room requirements, acquisition system requirements, etc. This paper makes an important contribution by providing a detailed survey and a new efficient approach on breast thermogram capturing.

Keywords: acquisition protocol, breast cancer, breast thermography, infrared thermography

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